All Psych Questions from whole Semester

A client is brought to the emergency department after being in a house fire. After determining the client is stable physically, what is the first phase of crisis intervention? 1. Assess the impact this experience has had on the client 2. Confront the reality of the crisis 3. Reassure client and family 4. Teach coping skills to client

1

A client presents with an inability to make decisions and function independently. The nurse knows these symptoms are indicative of which of the following disorders? 1. Dependent personality disorder 2. Paranoid personality disorder 3. Schizotypal personality disorder 4. Schizoid personality disorder

1

What test checks for Cushing's syndrome in which large amounts of cortisol are produced by the adrenal glands?

Dexamethasone suppression test

Brain imaging includes all of the following EXCEPT:

Dexamethasone suppression test (DST).

Brain imaging includes all of the following EXCEPT: Computed tomography Magnetic resonance imaging Positive emission tomography Dexamethasone suppression test

Dexamethasone suppression test (DST).

What are 3 common side effects of antipsychotics?

EPS, weight gain, and TD

During a client admission, it is important for the nurse to obtain the family history for mental disorders because:

Family history may assist in decisions about diagnosis and treatment.

*What collaborative treatment is helpful for patients in Mania?

Most urgent attention to nonstop physical behavior. Staff can set limits on teasing, sexual innuendoes

What are the signs and symptoms of Lithium Toxicity?

N/V, vision changes, ataxia, tinnitus (Know for test as per professor)

Advil is an ________, which should not be taken with lithium.

NSAID

After completing a third electroconvulsive therapy treatment, a patient says, " I haven't been able to remember anything since the last treatment, it wasn't like this last time." The nurse's best response is to ;

Notify the physician of the patient's increased memory loss.

After completing a third electroconvulsive therapy treatment, a patient says, " I haven't been able to remember anything since the last treatment, it wasn't like this last time." The nurse's best response is to:

Notify the physician of the patient's increased memory loss.

The client reports the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications?

Olanzapine ( Zyprexa)

The client reports the medication must be affective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medication?

Olanzapine (Zyprexa)

At what level of anxiety can effective learning no longer occur due to the patient's inability to concentrate and inability to understand even basic concepts?

Panic (psychological changes, no education at this time b/c they can't take it in)

What type of meds effect the brain including neurotransmitters, mind, behavior, emotions?

Psychotropic drugs

Before a newly admitted anxious client begins treatment with benzodiazepines, it is most important for the nurse to assess the client's:

Recent use of alcohol or other depressants

damages to the left side of the Parietal can cause

confusion, difficulty writing, math, aphasia, and agnosia

6. Lucky's accident occurred when he got away from Anna while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember the circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression

d

What neurotransmitter receptor is blocked with haloperidol?

dopamine

*When should you deal with a patient's anxiety?

during assessment before asking more

QID

four times a day

A client who is experiencing difficulties with working memory, planning and prioritizing tasks. in planning the nursing care, the nurse will apply knowledge that the symptoms represent problems with the:

frontal lobe

A client who is experiencing difficulties with working memory, planning and prioritizing, insight into his problems, and impulse control presents for assessment. In planning care, the nurse should apply knowledge that these symptoms represent problems with the

frontal lobe

A client says to the nurse, "everything makes me anxious now." The nurse knows that free-floating anxiety is a common theme in:

generalized anxiety disorder

What stage of erikson's development matches the following statement: "will i add anything of value to the world?"

generativity vs. stagnation

, knowledge is what type of positive schizophrenia delusion?

grandiose

*What are the four broad categories of positive schizophrenia symptoms?

hallucinations, delusions, loose association, and communication issues

TV, radio, newspaper talking to them is what type of positive schizophrenia delusion?

Reference

The nurse is assessing a patient diagnosed with obsessive compulsive disorder. The nurse realizes that in this disorder the patient:

has an obsession which is the instructive thought that cannot be diminished from consciousness

What do you do when someone is experiencing a panic or acute PTSD attack?

Stay with them and reassure them that they are safe

A client is admitted to the medical-surgical unit with a brain tumor. The nurse can anticipate that a client with a tumor in the frontal lobes will have problems with: Long-term memory Spatial orientation Sensory functions. The ability to think and plan.

The ability to think and plan. (frontal)

A psychiatric patient has greatly increased seemingly non-goal directed motor activity and seems terror stricken. He does not respond to nursing staff efforts to calm him. He is noted to have distorted perception and disordered thoughts. The initial intervention of highest priority is:

provide for patient safety

The client who has been taking buspirone (Buspar) for one month returns to the clinical for a follow up assessment. The nurse demonstrates that the medication is effective if the absence of which manifestation occurs:

rapid heartbeat or anxiety

A client was quite upset the entire time she was pregnant and made it clear that she did not want her unborn child. However, since the birth, she has become overly protective and refuses to let anyone near the infant which eagle defense mechanism does the nurse recognize in the clients behavior?

reaction formation

What ego-defense mechanism is described in the following: "A student hates nursing and only attended nursing school to please her parents. During career day, she speaks to prospective students about the excellence of nursing as a career." Regression. Sublimation. Reaction formation. Denial.

reaction formation

if the hippocampus is damaged, you would expect the person to have difficulty with:

recalling previously learned information

What is the purpose of taking an Anxiolytic?

relieves anxiety

soon after ECT, a patient is most likely to have problems with which of the following items on the mini mental status exam?

reporting the date

A client has admitted to the emergency department after car accident but does not remember anything about it. The client is using which defense mechanism?

repression

if a client repeatedly says that he has nothing on his mind during their therapy session, the nurse may evaluate this as indicative of:

resistance

When using benzos (-pam) like Lorazepam (Ativan) or clonazepam (Klonopin), drugs used to treat alcohol withdrawal, what assessment should you always perform?

respiratory, to watch for respiratory depression.

hippocampus is the area of brain responsible for

responsible for learning and memory

What ego-defense mechanism is described in the following: "A mother who's son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of Mothers Against Drug Driving." Suppression. Reaction formation. Rationalization. Sublimation.

sublimation

The nurse states to the client on the inpatient unit. "Tell me what's been on your mind?" what describes the purpose of this therapeutic technique?

to have the client initiate the conversation

MAOIs can't be taken with _______ containing foods because they can cause hypertensive crisis.

tyramine

Define the following phenomena as they relate to one-to-one relationships: Positive transference and negative transference

When a patient transfers feelings about their friends or family onto their nurse. (A set of feelings and thoughts about significant others in a client's past and current life that is transferred to caregiver (client transfers "CT") Positive transference is positive feeling for the therapist. Negative transference is negative feelings (hate, hostility, loathing, bitterness))

Which behavior would be most characteristic of a young man diagnosed as having an antisocial personality disorder?

When apprehended for committing a crime, to withdraw from contacts and remain mute and unresponsive.

If a client repeatedly says she has nothing on her mind during her therapy sessions, the nurse may evaluate this as indicative of:

a. Resistance.

The nurse working in disaster situations should also attend to his/her own self-care. To maintain positive self-care, the nurse should avoid: 1. Utilizing healthy coping mechanisms. 2. Monitoring one's own reactions. 3. Keeping a journal to write thoughts and feelings. 4. Focusing on improving interventions for the next crisis.

4

Which statement would be least likely when the nurse assess a client with histrionic personality disorder?

"I know I exaggerate and need more from staff than the other patients."

A client treated for hypochondriasis would demonstrate understanding of the disorder by which statement to the nurse?

"I know that I don't have a serious illness, even though I still worry about the symptoms."

you notice your client has a very tense body posture. What is your best response?

"I noticed your clenching your fists.... What's happening? "

The client has chronic pain disorder. Which statement by the client indicates to the nurse that the plan of care has been successful?

"I realize that my pain can be influenced by stress."

3. When caring for the client with ADHD, it is important for the nurse to include which of the following in the medical assessment

Height, weight, and blood pressure

Which of the following interventions would the nurse implement to address the client with feelings of abandonment? 1. Assist client to suppress feelings of abandonment. 2. Encourage client to never get involved in a relationship again. 3. Assist client to express deep rage at the ending of the relationship. 4. Assist client to verbalize feelings of abandonment in an appropriate manner.

4

What is the therapeutic range for Lithium

approximately 0.6 -1.2 is therapeutic range

Which of the following would be the most important considerations when evaluating an individual for a personality disorder?

culture

which of the following would be the most important considerations when evaluating an individual for a personality disorder?

culture

Mr. D is admitted to your unit and complains of "being depressed." He "wants to feel like his old self again." What nursing response would be most therapeutic?

d. "Tell me more about how things are so that I can better understand."

which of the following treatment programs would be most appropriate for homeless clients who judgment is severely impaired by paranoid delusions and command hallucinations due to medication nonadherence?

inpatient hospital-based care

Define the following phenomena as it relates to one-to-one relationships: Resistance

interfere w/ and disrupt smooth flow of feelings, memories, and thoughts the client's struggle against change resistive behaviors should be opening discussed, label the resistive behaviors, explore them

Dopamine is produced in which of the following locations:

substantia nigra

psycho analyst believe that behavior problems in adulthood are caused by:

unresolved issues in early development stages

Occipital Lobe is the area of brain responsible for

visual images, memory, formation language

What is the cardinal sign of sleep disturbance in major depressive disorder?

waking up early in the morning and not being able to go back to sleep (NOT sleeping too much)

Antidepressants you are always worried about _________ symptom, which is why some people choose not to take them.

weight gain

which behavior would be most characteristic of a young man diagnosed as having an antisocial personality disorder?

when apprehended for committing a crime, to withdraw from contacts and remain mute and unresponsive.

belief of being persecuted is what type of positive schizophrenia delusion?

Persecutory

The nurse would evaluate which of the following characteristics as indicative of healthy boundaries?

Taking responsibility to meet one's own needs.

In assessing a client for the MMSE, you ask the client the meaning of the proverb, "People who live in glass houses shouldn't throw stones." The client replies, "Because it will break." The interpretation of this finding is :

The client is likely a child who demonstrates Piaget's concrete operational thinking.

What Socioeconomic classes have the highest rates of suicide?

Super high or super low (highest and lowest social classes have highest risk of suicide)

1. Which of the following ego defense mechanisms describe the underlying psychodynamic of somatic symptom disorder

Suppression of anxiety

How do SSRIs work?

Allow more serotine to be available in brain by inhibiting uptake of serotonin

everything will be destroyed is what type of positive schizophrenia delusion?

Nihilistic

Dystonia

absent or poor muscle tone

if pt. experiences Neuroleptic Malignant Syndrome (NMS), what do you do?

call provider

What is paralanguage?

components of spoke language such as tone, pitch, volume, and rate of voice.

Where is Serotonin produced

in raphe nucleus

The ANA standards for the psychiatric nurse at the basic level of practice include:

a. Counseling clients to improve coping skills.

limbic system encompasses what parts of the brain

"Emotional Center of Brain, or reptilian brain" consists of the diencephalon, hippocampus, amygdala (LSD HA)

TCAs ending

-amine

How long do anxiety meds like buspirone (Buspar) take to work?

2-3 weeks

Age range of the Initiatiion vs. Guilt stage of Erikson's theory

3 - 5 years (preschool)

2. All of the following are considered examples of gravely disabled EXCEPT

A person lacks the resources to provide the necessities of life.

Which situation reflects the defense mechanism or projection?

A promiscuous wife accuses her husband of having an affair

which situation reflects the defense mechanism of projection?

A promiscuous wife accuses her husband of having an affair.

Paxil and Zoloft should be taken ________.

At the same time every day.

A client experiences a nightmare during his first night in the hospital. he describes the dream was about gunfire and people getting killed. The nurse's most appropriate initial intervention is to : A. Have the patient listen to relaxation tapes. B. Call the provider and report the incident. C. Stay with the client and reassure him of his safety.

C. Stay with the client and reassure him of his safety.

A patient with a personality disorder has revealed to staff that her family treats her cruelly. At the same time, she has told her family that she is receiving substandard care from the staff that repeatedly ignores her. The patient's goal is to:

Create a staff-family conflict that diverts the focus from the patient's need for self-examination

Neologism

Creation of a new word or expression common in schizophrenia

Schizophrenic people are 2x more likely to have ______, _____, and ______.

DM, decreased age length, increase in suicidality

A client is experiencing difficulties with working memory, planning, and prioritizing tasks. In planning the nursing care, the nurse will apply knowledge that these symptoms represent problems with the Parietal lobe Frontal lobe Occipital lobe Temporal lobe.

Frontal Lobe

A client who is experiencing difficulties with working memory, planning and prioritizing tasks. In planning the nursing care, the nurse will apply knowledge that these symptoms represent problems with the

Frontal lobe

which of the following medication's if given concurrently with lithium could produce a toxic affect?

Furosemide (Lasix)

The client is recently diagnosed with cancer and has a psychiatric diagnosis of bipolar disorder. During the follow-up visit, several weeks after receiving radiation therapy, the patient tells you that they are feeling depressed and hopeless. Which is most important to understand about the patient's ongoing intervention?

Hopelessness is the number one predictor of suicide in instances of chronic physical or mental illness

What's the psych version of "Assess the patient first"?

How do you feel about that?

*What signs and symptoms need to be present before a patient can be categorized as schizophrenia?

Include two of the following: delusions, hallucinations, disorganized speech, and also disorganized or catatonia, and negative symptoms that are not due to SUD

Which of the following is the most important factor in assessment of a suicide plan?

Is the method and weapon easily available?

What foods can you not have while taking MAOIs?

MAOI SPACESHIP (NARDIL, PARDIL ALIENS) IF YOU'RE AN ALIEN YOU CAN'T EAT TYRAMINE (HUMAN FOOD)

Physical boundaries such as fences or gates describes which of the following? Social boundaries. Personal boundaries. Material Boundaries.

Material boundaries.

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for: Memory impairment. Level of depression. Blood pressure. Mania.

Memory Impairment

"Establish trust, formulate contract for interventions" is the goal of which of the following phases of the therapeutic relationship? Orientation. Working. Termination.

Orientation or introductory

The nurse-patient relationship has three stages. Which stage is described in the example below? "Environment trust and rapport, establishing contract, setting expectations, general assessment, identifying strengths/limitations, develop goal"

Orientation phase (stages of the nurse-patient relationship Page 28)

What two SSRIs are the first line of treatment for depression also used or OCD, PTSD?

Paxil (Paroxatine) or Zoloft (Sertaline)

literal thinking seen in schizophrenia is a positive communication symptom of schizophrenia known as _________.

Piaget's concrete thinking

fixated on one topic, inability to change topic describes what positive symptom related to excessive speech pattern in schizophrenia?

Preservations

What is the goal of the Integrity vs. Despair stage of Erikson's theory

Reflection (Integrity achieve if positive & Gloom, doubt, and despair if negative)

The nurse states, "In the past you have made your appointments very well on your own." What is the rationale for the nurse's action?

Reinforce the client's sense of mastery by pointing out previous success

What part of the brain is responsible for arousal, wakefulness and sleep regulation?

Reticular Activating System.

Nurses working with abused clients commonly feel:

Sympathy for the victim, anger toward the abuser

1. Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific patient. b. The nurse shares the details of her divorce with the patient. c. The nurse makes arrangements to meet the patient outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.

a, b, c

4. Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply) a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Reassess intensity of suicidal thoughts and urges on a regular basis. d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

a, b, c

Which of the following is the healthiest form of communication?

a. Assertive communication

* Patients with schizophremia are at a high risk for __________.

always assess for suicide in schizophrenic patients

The Limbic system consists of which of the following structures?

amygdala, hippocampus, diencephalon

As a client with mental illness is discharged from a facility, the nurse invites the patient to a birthday party for a staff psychologist. Select the

analysis of this scenario. Correct c. The nurse's action blurs the boundaries of a therapeutic relationship.

which of the following is the healthiest form of communication?

assertive communication

6. When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

b

part of the treatment for OCD includes limiting the time the client can engage in __________.

engage in ritualistic behaviors

anhedonia

inability to feel pleasure (head gives me no pleasure)

Akathisia

inability to sit still (EPS from psychosis)

A voluntary patient mutilate herself whenever she leaves the unit. The nurse suggests that the use of 4-point restraints (restraining the patient's arms and legs to a bed in an isolation room) to prevent the patient from further harming herself. What question should be considered before this action is taken?

is this the least restrictive measure possible?

What important teaching should you give a patient concerning pregnancy and Divalproex (Valproic Acid, sodium valproate)?

it can cause birth defects such as spina bifida

What is the medication of choice for bipolar?

lithium

At what level of anxiety is a patient's learning enhanced?

mild

in the scheduled interaction with the patient, the nurse is giving the patient undivided attention. The nurse is using:

mindful listening

hallucinations occur in what lobe of the brain?

occipital lobe (on test)

What is Generalized anxiety disorder (GAD)?

preoccupation with worry about future, "free floating anxiety" anxiety that is somewhat random

What patient teaching should you give concerning when to take SSRIs each day?

take SSRIs at same time daily, typically in morning

What is the goal timeframe for decreased anxiety after the intake intake appointment?

within 1 month post D/C pt. is less anxious and will be able to tolerate mild anxiety

which outcome is most realistic and appropriate in planning care for a newly diagnosed client with an anxiety disorder?

within one month, the client will experience decreased frequency of episodes.

What are the four Antidepressant classes?

SSRI, SNRI, MAOIs, and TCAs

MAOIs can't be taken with in 2weeks of SSRI or SNRI because they can cause ______.

Serotonin Syndrome

What ego-defense mechanism is described in the following: A patient tells the rehab nurse, "I drink because it's the only way I can deal with my bas marriage and my worse job." Rationalization. Projection. Denial. Regression.

rationalization

The first step in crisis intervention is to achieve contact. When initiating contact with a client after a crisis, the nurse should not: 1. Collect information regarding health conditions. 2. Provide for emotional and physical safety of client. 3. Discuss the nurse's personal experiences with crises. 4. Identify feelings, reactions, and perceptions of client.

3

An adolescent client presents in the emergency room with right arm paralysis. A complete diagnostic workup is completed, but no organic cause for the paralysis can be determined. the client tells the nurse," I guess I have to miss my piano recital today.†' The nurse suspect the client may be experiencing:

Conversion disorder.

A mental health worker asks the nurse to explain how crisis intervention works. Which of the following is the most appropriate response of the nurse? Crisis intervention helps the client to:

Find a solution to an immediate & overwhelming problem

What is the goal of the Identity vs. Identity Confusion stage of Erikson's theory

Finding out who they are, what they are about, where they are going in life. Health exploration achieves positive identity otherwise, may be confusion

What ego-defense mechanism is described in the following: Attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors Rationalization. Projection. Denial. Regression.

rationalization

Selye referred to the body's response to stress as the:

General adaptation syndrome

preoccupation with worry about future, "free floating anxiety" anxiety that is somewhat random is a description of what anxiety disorder?

Generalized anxiety disorder (GAD)

Age range of the Identity vs. Confusion stage of Erikson's theory

13 - 21 years (puberty)

The concept of blaming as the cause of mental illness is based on the belief that:

a. People cause their own problems.

How do Neuroleptics or "Anti-psychotic" Drugs work?

Block Dopamine receptors

What is Separation Anxiety?

Excessive/inappropriate fear/anxiety of separation

Before a newly admitted anxious client begins treatment with benzodiazepines, it is most important for the nurse to assess the client's:

Recent use of alcohol or other depressants.

Does the term "Countertransference" refer to the patient or the nurse?

The nurse.

Cerebellum is the area of brain responsible for

balance, posture, movement (cerebellum is where alcohol effects brain)

In the therapeutic relationship, transference:

d. Should be examined.

Where does serotonin come from in the brain?

raphe nuclei

1. A pt. is a veteran of the war in Iraq is diagnosed with PTSD. He says to the nurse "I can't figure out why God took my buddy instead of me

" From the statement the nurse assesses which of the following in the client? Survivor's guilt

4. Present to ED w/ right arm paralysis, no known cause after testing, the patient says "I Guess I have to miss my piano recital!

" conversion disorder Medical condition that will prevent them from some task

The student nurses being oriented to the locked unit in the public mental hospital. He asks for the rules regarding patient's communication outside the hospital. Which staff response indicates the patient's rights are being followed?

"A patient can contact his or her attorney at any time. "

A client states to the nurse, "I see headless people walking down the hall at night." Which nursing response is appropriate?

"It must be frightening. I realize this is real to you, but there are not headless people here."

A client states to the nurse, "I see headless people walking down the hall at night." Which nursing response is appropriate? "Why do you think there are headless people here?" "Now let's think about this. A headless person would not be able to walk down the hall." "I don't see those people you are talking about." "It must be frightening. I realize this is real to you, but there are not headless people here."

"It must be frightening. I realize this is real to you, but there are not headless people here."

A client states to the nurse, "I see headless people walking down the hall at night." which nursing response is appropriate?

"It must be frightening. I realize this is real to you, but they are not headless people here."

your client with the personality disorder informs you, "a novice like you couldn't possibly help me. What I need right now is to leave this hospital." what is the best initial response?

"Where will you go?"

halfway through a 45 minute session with the nurse the client is silent often on for about 10 minutes. The nurse hypothesize is that the client may be experiencing resistance. Which of the following response is most therapeutic?

"You have been silent for long periods during the last 10 minutes "

What disorder is Lithium most often used to treat?

mood stabilizer, drug of choice for bipolar

In the scheduled interaction with the patient, the nurse is giving the patient undivided attention. The nurse is using:

d. Mindful listening

*when patient cannot slow down because they are in mania, they can risk __________.

fatigue and injury and even death

in the therapeutic relationship transference:

should be examined

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to:

anxiety

All phenomena that interfere with and disrupt expression of feelings, thoughts and memories: A. Resistance B. Countertransference C. Acting out D. Transference

A. Resistance

A client is blind with no physiological validation that since the client witnessed a fatal fire 7 days ago. The client does not appear anxious even though it is impossible for implementing activities of daily living. The nurse determines that the client is demonstrating:

La Belle indifference

Haldol, aka Haloperidol, can cause what two side effects you can visually see on your initial assessment?

akathisia, or restlessness, prolactinoma or lactation

What addiction are benzos (-pam) drugs used to treat?

alcohol withdrawal

What drug is used to treat Oculogyric?

benzotropine

A patient taking a psych med is experiencing fever, altered mental status, muscle rigidity, diaphoresis, and increasing confusion. What action do you take next?

call provider because they have Neuroleptic Malignant Syndrome (NMS)

when assessing a client in the cognitive realm, which of the following questions do you ask yourself?

can you follow what the client is saying?

when assessing a client in the cognitive realm (the patient's thoughts), which of the following questions do you ask yourself?

can you follow what the client is saying? (Is their IQ intact? Can they put a thought into words? ExA patient with dementia will have thoughts that are so scrambled that you won't be able to follow what they are saying to you.)

Does the following describe a cognitive or affective assessment: Knowledge and intellect like quizzes and tests?

cognitive

in which of the following therapies, which has been studied for the treatment of patients with borderline personality disorder, is mindfulness training a central component?

cognitive behavior therapy

Define the following phenomena as it relates to one-to-one relationships: Acting Out

destructive form of resistance, externalizing an internal conflict bring the acting out behavior to client's attention encourage client to talk about impulses rather than acting them out, encourage feelings before actions

What is PTSD?

development of S/S after exposure to a traumatic event, can be influenced by severity of stressor and availability of support systems, involves REEXPERIENCING trauma

which statement would be least likely when the nurse assesses a client with histrionic personality disorder?

" I know I exaggerated and need more from the staff than other patients."

The student nurse is being oriented to the locked unit in the public mental hospital. He asks for the rules regarding patients' communication outside the hospital. Which staff response indicates that patients' rights are being followed?

"A patient can contact his or her attorney at any time."

When a client with a major depressive disorder states, " I don't care about anything anymore," the nurse would respond:

"Are you feeling suicidal?"

A client on a psychiatric unit says, "it's a waste of time to be here. I can't talk to you or anyone." Which would be an appropriate therapeutic response?

"Are you feeling that no one understands?"

which of the following is an example of clarification of a clients message?

"Are you saying you were angry when that happened?"

Which of the following statements best describes symptoms of depression in children and adolescents?

"He is very irritable and agitated these past few months."

The nurse is working with a client that has a personality disorder. The client complains that the nurse never shares personal things about the nurse. The clients says, " I really would like to get to know you because you are easier to talk to than the other nurses." What is the most appropriate response to the client?

"I am glad to know it's easy to talk with me, but it is important for us to focus on helping you get through this crisis."

5. When a client has a situational crisis, communication strategies should include what statement

"I am sorry this happened to you"

When a client has a situational crisis, communication strategies should include which statement?

"I am sorry this happened to you"

In psychiatric inpatient setting, the nurse observes an adolescent client's peers calling the client names. In this context, which statement by the nurses exemplifies the concept of empathy?

"I can see that you are upset. Can you tell me how you feel?"

in a psychiatric inpatient setting, the nurse observes and adolescent clients peers calling the client names. In this context, which statement by the nurse exemplifies the concept of empathy?

"I can see that you are upset. Can you tell me how you were feeling? "

A client on an inpatient psychiatric unit has been prescribed tranylcypromine (Parnate) 30 mg qd. Which client statement indicates that discharge teaching has been successful?

"I have been craving a burger with lettuce & onion potato chips & coca cola"

A client on an inpatient psychiatric unit has been prescribed tranylcypromine (parnate) 30mg qd. which client statement indicates that discharge teaching has been successful?

"I have been craving a burger with lettuce and onion, potato chips and a Coca-Cola"

A client on an inpatient psychiatric unit has been prescribed tranylcypromine (Parnate) 30 mg qd. Which client statement indicates that discharge teaching has been successful?

"I have been craving a burger with lettuce and onion, potato chips and a coca cola."

A client on an inpatient psychiatric unit has been prescribed tranylcypromine (Parnate) 30 mg qd. Which client statement indicates that discharge teaching has been successful? -"I can't wait to order liver with some fava beans and a nice Chianti." -"Chicken teriyaki with soy sauce, apple sauce and tea sound great." -"I have been craving a burger with lettuce and onion, potato chips and a coca cola." -"For lunch tomorrow I'm having bologna and cheese, a banana and a cola."

"I have been craving a burger with lettuce and onion, potato chips and a coca cola."

A client who is admits to having frequent suicidal ideation is admitted to the psychiatric inpatient unit. During the assessment interview, the client says, " I don't really need to be here, I'm having much peace with myself now." The nurse should interpret that the client probably:

"I understand that you do not like this, but I must be able to see you at all times to make sure you are safe."

A social patient is placed on a one to one observation. When the nurse accompanies the patient to the bathroom, the patient loudly Shultz, "I'm sick of being followed around and treated like a child who can't be trusted." what would be the best response by the nurse?

"I understand that you do not like this, but I must be able to see you at all times to make sure you are safe."

A suicidal client is placed on one-to-one observation. When the nurse accompanies the client to the bathroom, the client loudly shouts, "I'm sick of being followed around and treated like a child who can't be trusted." What would be the best response by the nurse?

"I understand that you do not like this, but I must be able to see you at all times to make sure you are safe."

A suicidal patient is placed on one-to-one observation. When the nurse accompanies the patient to the bathroom, the patient loudly shouts, "I'm sick of being followed around and treated like a child who can't be trusted." What would be the best response by the nurse?

"I understand that you do not like this, but I must be able to see you at all times to make sure you are safe."

According to Schneidman's research, which client statement addresses the most common reason for suicide?

"I was cutting myself so that I could feel real again. It was an accident"

according to Schneidman's research, which clients name and address is the most common reason for suicide?

"I was cutting myself so that I could feel real again. It was an accident"

According to Schneidman's research, which client statement addresses the most common reason for suicide?

"I was cutting myself so that I could feel real again. It was an accident."

A nursing student expresses a belief that it is normal for older adults to experience forgetfulness and depression. The staff nurse should respond with:

"Impairments in memory and a depressed mood are pathologic changes that require professional intervention."

According to Schneidman's research, which client statement addresses the most common reason for suicide?

"My husband just left me, and I thought if I show him how much I loved him, he would come back."

What 5 factors should a nurse consider to be a better active listener?

"SOLER" Squarely face patient. Open posture. Lean forward. Eye contact. Relax.

a 36-year-old patient has been in the hospital for three weeks she has used Valium " to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse, "I do not know if I will make it without Valium after I go home. i'm already starting to feel nervous I have so many personal problems." which is the most appropriate response by the nurse?

"Starting today, you and I are going to think about some alternative ways for you to deal with those problems things that you can do to decrease your anxiety without resorting to drugs."

Open ended questions and statements result in fuller, more revealing responses by the client and frequently stimulate discussion. Which of the following in his example of this technique by the nurse?

"Tell me about your family."

mr. Diaz admitted to the unit of complaining of "being depressed." he "wants to feel like his old self again." which nursing response would be most therapeutic?

"Tell me more about how things are so I can better understand."

A client who has been on lithium therapy for six months has developed symptoms of mild arthritis. He tells the nurse that he wants to start taking Advil for his pain. Which of the following is the nurse's best response:

"Tylenol would be a better choice because Advil can raise your lithium level too high."

A client who has been on lithium therapy for six months has developed symptoms of mild arthritis. He tells the nurse that he wants to start taking Advil for his pain. Which of the following is the nurse's best response: "That is a good choice. Stronger analgesics would not be good for you." "Tylenol would be a better choice because Advil can raise your lithium level too high." "You will have to stop taking the lithium if you take any pain medication." "The Advil will make your lithium level fall too low and your symptoms may come back."

"Tylenol would be a better choice because Advil can raise your lithium level too high."

A client who has been on lithium therapy for six months has developed symptoms of mild arthritis. He tells the nurse that he wants to start taking Advil for his pain. Which of the following is the nurses best response:

"Tylenol would be a better choice because Advil can raise your lithium levels too high"

Your client with a personality disorder informs you, "A novice like you couldn't possibly help me. What I need now is to leave this hospital." What is your best initial response?

"What are you experiencing right now?"

Your client with a personality disorder informs you, "A novice like you couldn't possibly help me. What I need right now is to leave this hospital." What is your best initial response?

"Where will you go?"

John tells the nurse, "I think lights out at 10 PM on the weekend is stupid. We should be able to watch TV until midnight." which of the following is the most appropriate response from the nurse on the adolescent inpatient psychiatric unit?

"You may bring that up to the community meeting. "

during a recent counseling session with a depressed client, the psychiatric nurse observed signs of transference. Which statement by the client indicates the nurse is correct?

"You should remind me of my mom."

During a recent counseling session with a depressed, the psychiatric nurse observes signs of transference. Which statement by the client indicates the nurse is correct?

"You sure do remind me of my mom."

The instructor overhears the nursing student asked the client, "this is your third admission why did you stop taking your medication's?" Which statement by the instructor would be appropriately related to the students question?

"Your question implied criticism and could have the effect of making the client feel defensive."

A client on a psychiatric unit says " it's a waste of time to be here I can't talk to you anymore." Which would be an appropriate therapeutic response?

"are you feeling that no one understands?"

What is the therapeutic range for Lithium?

0.6 -1.2 is therapeutic range

A client comes to the clinic complaining of headaches. Further assessment reveals three one-inch bald spots at different locations on the client's scalp. The client states the headache and the bald spots resulted from an "accident." The client's partner, who has accompanied the client into the exam room, often finishes the client's sentences. The nurse should: 1. Ask the partner to remain in the waiting room while the client is examined. 2. Alert hospital security about the potential for violence. 3. Encourage the partner to remain with the client to provide information about the client's health. 4. Contact the local authorities.

1

A client who has been divorced for six months has recently been lying in bed most days, unable to care for the children. This is referred to as: 1. A situational crisis. 2. A stressful situation. 3. Lack of resilience. 4. Regression.

1

A client with a diagnosis of borderline personality disorder has had several hospitalizations for suicide attempts and self-mutilation. A priority nursing intervention for this client would include which of the following? 1. Safety maintenance 2. Social interaction 3. Anxiety reduction 4. Concrete communication

1

A community health-planning group is meeting to discuss increasing violence among children in the community. Which setting would be expected to have the lowest occurrence of violence? 1. Schools 2. Streets 3. Residential centers 4. Homes

1

A nurse is studying personality disorders. What statement would indicate that the nurse can differentiate between personality traits and personality disorders? 1. "Personality traits are persistent behavior traits that do not significantly interfere with an individual's life." 2. "Personality traits are lifelong maladaptive patterns." 3. "Personality traits are rigid, stereotyped behavioral patterns." 4. "Personality traits are enduring and deviate from societal norms."

1

A psychiatric nurse is providing an educational session to the emergency room staff to raise awareness on the topic of elder abuse. Which client is most at risk for elder abuse? 1. An 82-year-old woman with middle-stage dementia 2. A 73-year-old woman living in a poor neighborhood 3. A 70-year-old man with the recent diagnosis of heart disease 4. An 89-year-old man living with a mentally ill family member

1

A student nurse is working with a client on the inpatient unit who exhibits manipulative behavior. What action should the student incorporate into interactions with this client? 1. Limit setting 2. No-harm contract 3. Confront negative self-concepts 4. Matter-of-fact approach

1

An abused client in the inpatient unit recovering from injuries asks to attend Mass at the hospital chapel. The nurse understands that it is important for the client to: 1. Attend to spiritual needs in order to deal with what has happened. 2. Get back to a normal routine as soon as possible. 3. Find a distraction from the injuries. 4. Show an interest in what is going on in the world.

1

As a nurse advocate for the reduction of family elder abuse, a nurse: 1. Locates community resources for families. 2. Educates the public about legal consequences of violent acts. 3. Helps abused victims make it to the hospital for treatment. 4. Encourages abusers to come forward to talk about their issues.

1

Clients require stress management when they are easily frustrated, feel hopeless, cry easily, and are reluctant to leave home. An action that would not lead to a healthy decrease in the stress is to: 1. Utilize all familiar coping strategies. 2. Spend time with family and friends. 3. Not hold themselves directly responsible. 4. Maintain a daily routine.

1

Impulse control is part of the care plan for a client with borderline personality disorder. Which of the following is particularly important to include? 1. A no-harm contract 2. Identification of behavior patterns 3. Identification of support sources 4. Management of emotions

1

The nurse admits a client who initially presents as intelligent, articulate, and superficially charming. The client claims his admission to the mental health unit is a big mistake. He states that there was a mix-up in the emergency room and he was incorrectly identified. A probable diagnosis is: 1. Antisocial personality disorder. 2. Avoidant personality disorder. 3. Dependent personality disorder. 4. Obsessive-compulsive personality disorder.

1

The nurse finds that the client with a pain disorder has been in a physically and verbally abusive relationship. The client feels guilty and fears a loss of love. According to psychoanalytic concepts, this is believed to be a(n): 1. Unconscious conflict from childhood that was reawakened in adulthood by a similar situation. 2. Environmental factor. 3. Stress related to relationships. 4. Brain abnormality.

1

The nurse is caring for a client with somatization disorder. When providing a report to the staff on the next shift, it is important for the nurse to relate the: 1. Amount of time the client talked about physical complaints. 2. Trigger for the client's worries. 3. Use of abdominal breathing at the first sign of anxiety. 4. The client's source of the original anxiety.

1

The nurse is presenting an in-service on dissociative disorder. The nurse knows that which of the following is most often used to explain the occurrence of dissociative disorder in psychiatric clients? 1. Psychosocial theories 2. Biological theories 3. Genetic theories 4. Physical theories

1

The nurse is working with a client who exhibits a grandiose sense of self-importance. This characteristic is associated with which of the following personality disorders? 1. Narcissistic personality disorder 2. Avoidant personality disorder 3. Histrionic personality disorder 4. Dependent personality disorder

1

The nursing diagnosis that would not be made for a client having experienced a situational crisis is: 1. Risk for Loneliness. 2. Risk for Self-directed Violence. 3. Spiritual Distress. 4. Impaired Social Interaction.

1

The student nurse is comparing the essential characteristics of each cluster of personality disorders. The student correctly identifies the essential characteristics of cluster C disorders as: 1. Anxiety. 2. Pervasive distrust. 3. Impulsivity. 4. Openness.

1

What is the most therapeutic approach of a nurse toward a victim of violence? 1. Being supportive, nurturing, and empathetic 2. Educating the client on how to avoid future incidents 3. Distracting the client to minimize feelings of despair and guilt 4. Maintaining objectivity and offering short, to-the-point responses

1

What would the nurse expect to find when assessing a client with obsessive-compulsive personality disorder? 1. Difficulty completing projects 2. A sense of spontaneity 3. Open expression of feelings 4. Ability to tolerate mistakes

1

Which of the following statements by a client would reflect a turning point? 1. "This was difficult for me, but I have learned how to manage myself in my new job." 2. "If only they would give me another chance, I know I could do better." 3. "I will get them for this." 4. "I guess I deserved this. I was not a great employee."

1

Which of the following statements made by an abusive family member in a counseling session indicates that the individual has learned positive coping skills? 1. "I feel more prepared to care for my father now that I know where to go for assistance." 2. "I am so sorry I lost control; it will never happen again." 3. "From now on I will make sure that my father's needs are met." 4. "Now that I realize I treated my father unfairly, I will change my ways."

1

Which statement should include communication strategies when a client has had a situational crisis? 1. "I am sorry this happened to you." 2. "I know just how you feel." 3. "It's best to stay busy." 4. "It could have been worse."

1

Who among the following females is at greatest risk of becoming a victim of sexual abuse? 1. A female who carpools with a male coworker 2. The partner of a man with a strong sex drive 3. An attractive 14-year-old female who dresses in a manner that makes her appear older 4. A 45-year-old widow who goes to a local club to meet new people

1

MCSA Establishing and maintaining the therapeutic nurse-client relationship differs according to the client's cultural background. The nurse is guided by knowledge of which of the following? 1. A client's religious beliefs may interfere with constructive change. 2. Alternative values should always be discussed with the client. 3. Clients who believe family problems should not be discussed with strangers should not be coaxed into doing so. 4. Exploring religious beliefs with the client is not recommended.

1 Rationale 1: A client's religious beliefs could prevent the client from taking constructive action to change behaviors. Exploring religious beliefs and alternative values is useful if the client initiates such an action. Clients raised in restrictive family environments may not realize that a ban on discussing family problems with others is unhealthy. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Establish and maintain one-to-one relationships within the context of the client's cultural background. Question 28

MCSA The nursing assistant asks the psychiatric nurse the location of the first asylum for the mentally ill. Which response by the nurse is most appropriate? 1. "The first asylum for the mentally ill was in Morocco." 2. "This is not part of your role on this unit." 3. "The first asylum for the mentally ill was St. Mary of Bethlehem (Bedlam)." 4. "Why do you want to know this?"

1 Rationale 1: An asylum for the mentally ill was built in Fez, Morocco early in the 8th century. The hospital of St. Mary of Bethlehem (Bedlam) in England followed later in history. There is no reason not to answer the question. Continued learning should always be encouraged. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Question 22

MCSA The nurse is working with a client in the dayroom. Which of the following behavioral cues by the nurse may indicate a countertransference reaction? 1. Annoyance and hostility toward a client 2. Ordinary concern for the client 3. Feeling comfortable after meeting with the client 4. Thinking about the interaction after meeting with a client

1 Rationale 1: Annoyance and hostility toward a client are signs of countertransference, indicating that the nurse has assigned irrational meaning to the nurse-client relationship that belongs to other past relationships of the nurse. Ordinary concern, feeling comfortable, or mentally reviewing the interaction after meeting with the client are expected behaviors and do not indicate countertransference. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship. Question 14

MCSA The home health nurse is caring for a number of clients with chronic illnesses. Given World Health Organization (WHO) research, the nurse realizes that the client with which of the following is at greatest risk for mental disability? 1. Bipolar disorder 2. Panic disorder 3. Psychotic disorders 4. Anxiety disorders

1 Rationale 1: Bipolar disorder ranks as number six on the list of top 10 causes of mental disability worldwide. The terms anxiety disorders and psychotic disorders reflect general categories of mental disorders and could constitute a number of more specific disorders not on the list. While panic disorder is classified as an anxiety disorder, it is not on the WHO list of the top 10 causes of mental disability worldwide. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 18

MCSA The nurse is working with the client to identify self-defeating thoughts, feelings, and behaviors. Which behavior by the client does the nurse identify as resistance to the therapeutic process? 1. Changing the subject when asked to explore a specific topic 2. Becoming silent when asked to identify unhealthy behaviors 3. Sharing feelings, fantasies and motives with the nurse 4. Changing behavior outside of the one-to-one therapeutic relationship

1 Rationale 1: Changing the subject when asked to explore specific topics or concerns may indicate that the client is not ready for investigative work and is resisting the therapeutic process. Becoming silent may mean that the client is pondering the question carefully before answering. Sharing feelings, fantasies, and motives, or changing behavior outside the one-to-one relationship are signs that the client is participating in the therapeutic process and is ready for investigative work. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Encourage the client's systematic use of abilities and behaviors most often associated with growth-producing outcomes. Question 6

MCSA The nurse is working with a client who appears unwilling to explore a specific topic during the working phase of the therapeutic relationship, by continually changing the subject. Which of the following nursing strategies would be most helpful? 1. Clarify the client's refusal to explore the topic by labeling it as resistance. 2. Accept the client's refusal to talk about the topic by changing the subject. 3. Allow the client to decide the appropriate time to explore the topic. 4. Insist the client discuss the topic by examining the origin of the behavior.

1 Rationale 1: Clarifying the client's refusal to explore a topic by properly labeling it as resistance will encourage open discussion of the resistant behavior and foster development of insight. Allowing the client to decide the appropriate time to discuss the topic, or accepting the resistant behavior, will further impede and delay the therapeutic process. Insisting the client discuss the topic may produce the opposite effect and the client may become hostile or silent. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Encourage the client's systematic use of abilities and behaviors most often associated with growth-producing outcomes. Question 9

MCSA The nurse receives the shift report on a newly admitted client with a history of drug abuse and prostitution. Prior to hospitalization, the client's parental rights were terminated. Which of the following actions best demonstrates the nurse's ability to enhance self-knowledge? 1. The nurse will examine his or her own feelings with regard to this client. 2. The nurse will ignore the challenge to his or her self-view. 3. The nurse will ask for guidance from the charge nurse. 4. The nurse will review the current literature pertaining to drug addiction.

1 Rationale 1: Examining one's own feelings regarding a client who engages in behaviors that are outside the nurse's behavior norms promotes self-awareness and acceptance of deviance, which then allows the nurse to respond with compassion and maintain empathy when meeting the client for the first time. Asking for guidance or reviewing the literature before examining one's feelings indicates that the nurse is unaware or uncomfortable with feelings and relies on others for guidance. Ignoring how one's self-view might be challenged by a patient situation indicates the nurse is not able to confront how the diversity of client behaviors or experiences impacts the quality and nature of the nurse's relationships with others. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatric-mental health nurses. Question 3

MCSA A client approaches the nurse grimacing, talking in a whisper, and waving his arms. Which of the following actions best demonstrates the nurse's ability to develop a therapeutic relationship? 1. Greet the client by name to demonstrate caring. 2. Assist the client to leave the area to prevent distress to others. 3. Ignore the client to convey disapproval of the behavior. 4. Confront the client about the behavior to encourage insight.

1 Rationale 1: Greeting the client by name conveys that the nurse accepts the client's uniqueness without pre-judging the client's behavior. Ignoring the client is disrespectful and communicates indifference. Assisting the client to leave demonstrates that the nurse is uncomfortable facing behavior that is outside the social norm. Confronting the client indicates that the nurse has preconceived ideas of what is normal behavior for the client. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatric-mental health nursing practice. Question 6

MCSA The nurse and client have moved from the orientation phase to the working phase of the nurse-client relationship. Which of the following nursing strategies would assist the client to make constructive changes in a dysfunctional response pattern that is occurring during the early working phase of the nurse-client relationship? 1. Teach the client specific problem-solving strategies. 2. Determine a time and place for working on constructive changes. 3. Remind the client that constructive changes are expected before discharge occurs. 4. Reassure the client that confidentiality will be maintained.

1 Rationale 1: Helping the client to learn and apply problem-solving strategies will provide the knowledge and tools the client needs to make constructive changes. Confidentiality issues and negotiation for the time and place of interactions should be addressed in the orientation phase prior to entering the working phase. Reminding the client that change is expected before discharge may produce stress and anxiety placing undue pressure on the client. This could inhibit the relationship and deter progress toward the goals. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 17

MCSA A nurse educator is teaching a group of students the definition of a mentally healthy individual. The nurse educator knows that an individual is considered mentally healthy when which of the following concepts give evidence to psychological, emotional, and social health? 1. Behavior 2. Intrapersonal relationships 3. Gender 4. Age 5. Interpersonal relationships

1 Rationale 1: In general we consider an individual to be mentally healthy when what that person does (the person's behavior), how that person relates to others (the person's interpersonal relationships between oneself and others), and how that person relates to him- or herself (the person's intrapersonal relationships within the mind or the self) give evidence of psychological, emotional, and social health. There is no evidence that age and gender play a role in defining a mentally healthy individual. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Learning Outcome 01-3: [ Question 12

MCSA A nurse is teaching a group of students about the stigma that is often associated with mental illness. The nurse tells the group that stigma associated with mental illness is about which of the following? 1. Disrespect 2. Intelligence 3. Respect 4. Appreciation

1 Rationale 1: It causes others to keep their distance from someone who is "not right" and results in social isolation for the stigmatized person Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Explore the meaning of stigma for clients, families, friends, communities, and mental health caregivers and agencies. Question 26

MCSA The unit manager is consistently advocating for self-awareness among the psychiatric-mental health nursing staff in order to promote quality care. From which theoretical base is the unit manager operating? 1. Jean Watson's theory of human caring 2. Dorothea Orem's theory of self-care 3. Martha Rogers's principles of homeodynamics 4. Sister Callista Roy's adaptation theory

1 Rationale 1: Jean Watson's theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose as barriers to transpersonal caring. Roy's adaptation theory (coping and adapting to environmental stimuli), Rogers's principles of homeodynamics (human and environmental interaction), and Orem's theory of self-care (matching nursing systems of care with clients' levels of self-care functioning) have different emphases. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatric-mental health nursing most directly. Question 27

MCSA The nurse is caring for a client who repeatedly talks about the role of spirituality in curing depression. Which approach best demonstrates the nurse's acceptance of the client? 1. Listen to the client in a supportive manner. 2. Share opinions regarding the role of spirituality in daily life. 3. Encourage the client to consider other curative factors. 4. Ignore the client's focus on spirituality.

1 Rationale 1: Listening to the client in a supportive manner demonstrates that the nurse is refraining from judging the client's position and is willing to listen in order to understand the client's views. Ignoring the client's viewpoint conveys rejection of the client. Encouraging the client to consider other factors disregards the client's communication. Sharing opinions is not a therapeutic use of self. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 11

MCSA While caring for the client with a mental illness, which action by the psychiatric-mental health nurse best indicates use of Hildegard Peplau's nursing theory? 1. Establishing a therapeutic nurse-client relationship 2. Intervening to enhance the client's abilities to perform self-care 3. Assessing client's interactions with their environment 4. Evaluating the effectiveness of the client's coping and adaptation skills

1 Rationale 1: Peplau conceptualized the one-to-one nurse-client relationship in which the client can accomplish developmental tasks and practice healthy behaviors. Dorothea Orem identified the goal of self-care and focused on the client's abilities to perform self-care to maintain life, health, and well-being. Martha Rogers' work gave psychiatric nurses a mandate to use holistic principles and to consider human beings and environmental interactions. Sister Callista Roy's adaptation theory related the notion of coping or adapting to stimuli as humans interact with their environment. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatric-mental health nursing most directly. Question 24

MCSA The nurse is caring for a newly admitted client who has not showered in several days and emits an offensive odor. Which of the following actions best conveys respect for the client? 1. Assess the client's abilities and needs related to performing self-care. 2. Be honest with the client about how his or her appearance affects others. 3. Explain unit expectations regarding activities of daily living to the client. 4. Ignore the client's body odor to minimize causing humiliation.

1 Rationale 1: The nurse conveys respect for the client's ability to be in control by first assessing strengths, as well as areas that require assistance. Explaining unit expectations, or being honest with the client before assessment, does not promote dignity and communicates possible rejection of the client by the nurse. Ignoring the client's body odor reflects the nurse's own discomfort when caring for clients who are struggling to meet their basic needs. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues. Question 26

MCSA The nursing assistant verbalizes to the psychiatric nurse that normal people don't have mental disorders. Which approach by the nurse would be best? 1. Instruct the nursing assistant that anyone can have a mental health problem. 2. Alert the nursing manager of the nursing assistant's remark. 3. Refer the nursing assistant back to the psychiatric orientation materials. 4. Ignore the comment; the nurse has no responsibility in this situation.

1 Rationale 1: The nurse should instruct that given the right circumstances, anyone can have a mental health problem or disorder. The nursing assistant's ability to be therapeutic with clients may be decreased if misinformation is not corrected. Referring the assistant back to the orientation materials, alerting the nursing manager, and ignoring the comment do not address the situation directly. The nurse has an opportunity to be a positive role model and teacher and promote therapeutic care. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Define and explain mental disorder. Question 5

MCSA A nurse is taking a class on providing culturally competent care for clients with severe mental illnesses. Which response best reflects the nurse's self-awareness of the sociocultural factors influencing his or her beliefs? 1. "When I was growing up, my parents believed that mental illnesses were the work of evil spirits." 2. "All that I need to understand about the culture of mental illness is available on the Internet." 3. "My father was a psychiatrist, so I am very knowledgeable about how to work with mental illnesses." 4. "I have been through therapy, so I know what to expect from clients with mental illnesses."

1 Rationale 1: The nurse who acknowledges what parents or significant others have said about mental illness recognizes that one's heritage has an impact on one's beliefs and can influence one's practice. Stating that a parent's occupation makes one knowledgeable about mental illnesses suggests arrogance on the part of the nurse and does not invite self-reflection. Believing that one can learn about cultural differences through popular media does not promote self-awareness or critical thinking. Stating that because of therapy one understands the culture of those with mental illness suggests that psychotherapy is the only way to gain awareness of sociocultural differences. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice. Question 18

MCSA The nurse has just taken a continuing education class on assertive communication techniques. Which response best demonstrates that the nurse understands assertive behavior? 1. "No, I cannot work for you on Sunday." 2. "Yes, they always ignore staff requests." 3. "It would be selfish to ask for time off." 4. "I will demand a change in my schedule."

1 Rationale 1: The nurse who is assertive knows that one has the right to refuse a request without feeling guilty. Demanding a change demonstrates aggressive behavior. Stating it would be selfish demonstrates nonassertive behavior. Stating that they always ignore requests reflects aggressive behavior. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others. Question 29

MCSA Due to a staff member's absence, the nurse is reviewing staff assignments for the day. Which task can the nurse delegate to the psychosocial rehabilitation worker? 1. Conflict resolution teaching to a small group of clients 2. Comparison of physician's orders with the medication records 3. Routine medication administration to a stable client 4. Assessment of a long-term client

1 Rationale 1: The psychiatric rehabilitation worker teaches clients practical, day-to-day skills for living in the community, which might include conflict resolution. Medication administration, comparison of physician orders with medication records, and assessment fall within the nursing role and cannot be delegated. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatric-mental health nurse and other members of the mental health team. Question 10

MCSA The nurse assesses that the mental health client has problems choosing productive, safe leisure activities. Which member of the mental health team should the nurse consult with? 1. Recreational therapist 2. Occupational therapist 3. Attending psychiatrist 4. Clinical psychologist

1 Rationale 1: The recreational therapist plans and guides recreational activities to provide socialization, healthful recreation, and desirable interpersonal and intrapsychic experiences and will be the member of the healthcare team to take the lead in the implementation of this portion of the treatment plan. While all members of the team work together, the psychiatrist is responsible for the diagnosis and treatment of the mental illness. The occupational therapist teaches self-help activities and helps prepare the client for employment. The clinical psychologist's foci are psychotherapy, behavior modification, and psychological testing. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatric-mental health nurse and other members of the mental health team. Question 8

Age range of the Autonomy vs. Shame & Doubt stage of Erikson's theory

1 - 3 years (toddler)

What is the diagnostic Criteria for PTSD?

1 or more of the following: characterized by intrusive memories, recurrent dream, flashbacks, prolonged physiological reaction and/or stress, AVOIDANCE OF STIMULI (people, places, activities, etc), negative alterations in cognition/mood

The caregiving team may also need support to process traumatic events in the community or in the care setting. Critical Incident Stress Debriefing (CISD) is a model of effective group crisis intervention. This group intervention: Standard Text: Select all that apply. 1. Includes a several-phase group discussion. 2. Includes psychological and psychoeducational elements. 3. Includes guidelines similar to AA. 4. Is most effective in emergency settings.

1,2

MCMA The nurse is working with a client who started therapy after losing his wife in an automobile accident. Which of the following client behaviors indicates he is ready to terminate the therapeutic nurse-client relationship? Standard Text: Select all that apply. 1. Initial client treatment goals have been accomplished. 2. Symptoms no longer interfere with the client's comfort. 3. The client refuses to change due to unresolved resistances. 4. Dissatisfaction with interpersonal relationships is expressed. 5. Client well-being and satisfaction is dependent upon the nurse.

1,2 Rationale 1: Initial client treatment goals have been accomplished. Planned goals have been achieved. Rationale 2: Symptoms no longer interfere with the client's comfort. Relief from the presenting problem has occurred. Rationale 3: The client refuses to change due to unresolved resistances. A disruption in the one-to-one relationship has occurred due to a major impasse. Rationale 4: Dissatisfaction with interpersonal relationships is expressed. The client has not developed sufficient improvement in social functioning for the relationship to end. Rationale 5: Client well-being and satisfaction is dependent upon the nurse. The client should experience self-satisfaction and attainment of an independent identity before termination can occur. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 25

MCMA During an admission assessment on an adult unit, the nurse is thinking that the client's beliefs and actions regarding commonly accepted health practices are "bizarre." To help establish the presence of a mental disorder, the nurse should first collect information about the client's: Standard Text: Select all that apply. 1. Occupational history. 2. Psychiatric history. 3. Culture. 4. Age. 5. Family history.

1,2,3 Rationale 1: Occupational history. Occupational history will provide data regarding the client's ability to function effectively (part of definition of mental disorder). Rationale 2: Psychiatric history. Psychiatric history will provide valuable subjective data to assist in the analysis of current thoughts and behaviors. Rationale 3: Culture. Behavior that is considered bizarre in one cultural context may be considered acceptable and even desirable in another. Rationale 4: Age. While age can provide parameters for normal growth and development in relation to thinking and behavior, age in this situation with the adult is not useful. Rationale 5: Family history. Family history is not generally correlated to beliefs about health practices. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Analyze why the term "deviant behavior" lacks a definition that covers all situations. Question 9

Different types of crises arise from different causes. Maturational crises can involve: Standard Text: Select all that apply. 1. Transition from student to worker. 2. Normal transitions of human development. 3. Life cycle changes. 4. Changes such as marriage or retirement. 5. Life changes from a flood.

1,2,3,4

MCMA The psychiatric-mental health nurse is planning a personal program of continuing education to better meet the challenges of the future in psychiatric nursing practice. What areas should be included in the nurse's plan for continuing education? Standard Text: Select all that apply. 1. Psychiatric nursing care in nontraditional settings 2. Psychopharmacology 3. Genetic research 4. Psychobiology 5. Physical health of psychiatric clients

1,2,3,4,5 Rationale 1: Psychiatric nursing care in nontraditional settings. Settings continue to expand from hospitals and traditional settings to alternative and nontraditional settings. Rationale 2: Psychopharmacology. Newer psychopharmacologic agents with fewer side effects continue to grow. Rationale 3: Genetic research resulted in significant knowledge related to the genetic basis of inherited mental disorders that must be integrated into various areas of psychiatric nursing practice. Rationale 4: Psychobiology. As there has been a knowledge explosion in psychobiology, the greatest challenge for psychiatric nursing is the integration of psychobiologic knowledge into clinical practice while maintaining a focus on caring. Rationale 5: Physical health of psychiatric clients is a sometimes overlooked dimension of care especially among the severely and persistently mentally ill clients living in community settings is a new area of focus and challenge for psychiatric nurses. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 23

The nurse knows that performing an assessment on a client with dissociative disorder can be challenging. The nurse knows it is important to include which of the following in the assessment? Standard Text: Select all that apply. 1. Memory 2. Identity 3. Consciousness 4. Client's spouse 5. Awareness of time

1,2,3,5

The nurse working with a client who is a survivor of a four-car accident knows that there are risk factors that influence this client's response to the traumatic experience. The risk factors are: Standard Text: Select all that apply. 1. Prior history of crises. 2. Believing that receiving help is a sign of weakness. 3. Cultural expectations that prohibit asking others for help. 4. Feelings of loss. 5. Pre-existing psychiatric symptoms and diagnosis.

1,2,3,5

The nurse is working with a client who has been diagnosed with a somatoform disorder. The nurse knows it is important to include which of the following interventions in the client's plan of care? Standard Text: Select all that apply. 1. Encourage verbalization of feelings. 2. Encourage the client to write in a journal 3. Establish a weekly routine 4. Establish a trusting relationship. 5. Encourage the discussion of physical symptoms

1,2,4

A client who is being physically and sexually abused states, "God doesn't want to bother with me. Am I an evil person? Why do these things always happen to me? What's wrong with God?" These statements indicate that the client is most likely experiencing: Standard Text: Select all that apply. 1. Spiritual distress 2. Anger 3. Altered thought process 4. Fear 5. Hopelessness

1,2,4,5

MCMA The nursing student asks the nurse the reason that knowledge of nursing theories is important. The nurse should respond that nurses use nursing theories to do which of the following? Standard Text: Select all that apply. 1. Organize assessment data. 2. Generate goals. 3. Evaluate outcomes. 4. Plan interventions. 5. Generate nursing actions.

1,2,4,5 Rationale 1: Organize assessment data. Nurses use theories to assist them to organize and think about human responses and data in meaningful ways. Rationale 2: Generate goals. Nurses use theories to generate goals that have meaning for clients and reflect desired outcomes to promote health and well-being. Rationale 3: Evaluate outcomes. Nurses use theories to assist in the identification of areas for evaluation of client progress toward goals. Rationale 4: Plan interventions. Nurses use theories to plan interventions that address human responses as they interact with both the internal and external environments. Rationale 5: Generate nursing actions. Nurses use theories to provide guidance in the focus for nursing actions that promote health as defined by each theory. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain why you should be capable of functioning in all theories of care. Question 29

MCMA The nurse is teaching the client regarding the concept of mental disorders. In instructing the client, what areas should be covered in the explanation of what impacts the determination of a mental disorder? Standard Text: Select all that apply. 1. Social conditions 2. Biochemistry 3. Mother-child interactions 4. Brain structure 5. Culture

1,2,4,5 Rationale 1: Social conditions. The appropriateness of behavior is judged as plausible or not plausible according to a set of social, ethical, and legal rules that define the limits of appropriate behavior and reality. Rationale 2: Biochemistry. Research has shown that brain chemicals and processes are frequently altered in mental disorders. Rationale 3: Mother-child interactions. While family interactions are important in mental health, current theory and research emphasize a more biological and societal definition. Rationale 4: Brain structure. Contemporary diagnostic testing has demonstrated some structural differences in persons who have mental disorders. Rationale 5: Culture. Behavior may be considered part of a mental disorder in one culture, but perfectly normal and acceptable in another. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Define and explain mental disorder. Question 6

Which of the following reflects the concepts of crisis intervention? Standard Text: Select all that apply. 1. Includes interdisciplinary treatment 2. Restoring the individual to a sense of equilibrium 3. Used when client is unable to overcome the effects of a crisis 4. Utilized when client becomes suicidal 5. Short-term, action-oriented assistance, focused on problem-solving

1,2,5

A nurse is effective in crisis work when the nurse: Standard Text: Select all that apply. 1. Collaborates with other health professionals. 2. Stays in control of clients. 3. Has realistic expectations. 4. Respects clients. 5. Develops own outlets for stress.

1,3,4,5

The nurse's new job description at the generalist level of practice reflects the definition of psychiatric-mental health nursing and the Psychiatric-Mental Health Nursing Standards of Practice (ANA, APNA, ISPN). In which of the following areas might the nurse plan programs and intervention to fulfill employment expectations? Standard Text: Select all that apply. 1. Stress management strategies 2. Early diagnosis of psychiatric disorders 3. Parenting classes for new parents 4. Family and group psychotherapy 5. Medication teaching for anti-anxiety medications

1,3,4,5 Rationale 1: Stress management strategies address health, wellness, and care of mental health problems and are appropriate for psychiatric-mental health nursing at the generalist level of practice. Rationale 2: Early diagnosis of psychiatric disorders is generally not consistent with the definition or practice of psychiatric-mental health nursing especially at the generalist level. Rationale 3: Parenting classes for new parents provide teaching that is consistent with the prevention of mental health problems and is consistent with psychiatric-mental health nursing at the generalist level of practice. Rationale 4: Family and group psychotherapy is consistent at the advanced practice registered nurse level but not the generalist level. Rationale 5: Medication teaching for anti-anxiety medications promotes quality of care for persons with psychiatric disorders and is vital for psychiatric-mental health nursing practice at the generalist level of practice. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatric-mental health nursing. Question 2

Crisis situations are turning points in a client's life. This can result in: Standard Text: Select all that apply. 1. Something close to a pre-crisis state of functioning. 2. A realistic perception of the event. 3. Dysfunctional personal coping. 4. Anticipatory guidance assistance. 5. A more negative or positive state.

1,3,5

A suicidal client is placed on one-to-one observation. When the nurse accompanies the client to the bathroom, the client loudly shouts, "I'm sick of being followed around and treated like a child who can't be trusted." What would be the best response by the nurse? 1. "I understand that you do not like this, but I must be able to see you at all times to make sure you are safe." 2. "You don't have to be so loud. I do trust you, but I can't change the rules for you." 3. "Since this is upsetting to you, leave the door open and I'll wait outside it for you." 4. "Being angry and uncooperative won't change anything. I can't leave a suicidal client alone."

1. "I understand that you do not like this, but I must be able to see you at all times to make sure you are safe."

What 3 ethnicities are most likely to commit suicide?

1st: Caucasians. 2nd: American Indians and Alaskan natives.

A 30-year-old man is accused of sexual assault and is arrested by law enforcement. During the interview with the forensic nurse, the client uses flattery and compliments the nurse's interview skills. He asks the nurse for her phone number so his lawyer can contact her as an expert witness for his case. How should the nurse respond? 1. Tell the client that she is listed in the phone book. 2. In a way that establishes the boundaries of the nurse-client relationship. 3. Tell the client that the nurse is working for the prosecution. 4. In a way that nurtures the client's feelings.

2

A client describes being depressed, out of control, and unable to make decisions. Upon assessment, the nurse determines that the client has recently experienced a fire at home in which many important files as well as family mementos were destroyed. Many things that were not totally burned were water damaged. The nurse knows that identifying the origin of the crisis: 1. Motivates the client and family to take significant action in relationships. 2. Promotes an increased opportunity for interventions to be effective. 3. Decreases communication with significant others. 4. Assists with identifying the level of grief.

2

A client is newly diagnosed with dissociative identity disorder. To support this client, who is struggling to accept the diagnosis, the nurse would: 1. Flood the client with stressful stimuli. 2. Actively listen to each identity state and provide support. 3. Assess for secondary gain to confront the client. 4. Discourage the use of psychometric tests.

2

A client is participating in therapy that explores the effects of unrealistic thought patterns on daily life. Which type of therapy is the client likely engaging in? 1. Family therapy to explore dynamics 2. Cognitive therapy techniques 3. Alternate-Nostril Breathing 4. Repetitive Transcranial Magnetic Stimulation

2

A client is prescribe lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg in a 24 hour period. The client would be able to receive ____ PRN doses as the maximum number of PRN lorazepam doses.

2

A client is prescribe lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg in a 24 hour period. The client would be able to receive ____ PRN doses as the maximum number of PRN lorazepam doses. 2 4 1 8

2

A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg in a 24 hour. The client will be able to receive ___PRN doses as the maximum number of PRN lorazepam doses.

2

A client presents to the community clinic describing abdominal pain, refuses to complete informational forms, and dismisses the nurse's assessment attempts while demanding to be seen immediately by a doctor. Which approach would be best for the nurse to use when assessing for somatoform disorders? 1. Realize client judgment is intact. 2. Avoid personalizing the behavior by recognizing that somatization is part of the illness. 3. Have sympathy for the psychopathology of the disorder. 4. Expect the client to respond appropriately to the nurse's need to complete the assessment.

2

A client with a poorly regulated corticotropin-releasing factor (CRF) will most likely have difficulties: 1. Relating to others. 2. Coping with stress. 3. Balancing life issues. 4. Interpreting the environment.

2

A nurse is taking the history of a client and suspects that the client has been sexually abused. Which question will prompt a response that will aid the nurse in making an accurate assessment? 1. "Do you like to dress in provocative outfits?" 2. "Has anyone touched you in a way that made you feel uneasy or uncomfortable?" 3. "Do you have any bruises anywhere on your body?" 4. "How is your relationship with your parents and older siblings?"

2

An appropriate ongoing, long-term treatment goal for a victim who experienced sexual abuse eight months ago is to: 1. Establish rapport and build a trusting nurse-client relationship. 2. Move from victim to survivor status. 3. Become aware of legal rights. 4. Involve significant others in the treatment plan.

2

How can the nurse differentiate the client with obsessive-compulsive personality disorder from a client with perfectionist personality traits? 1. Clients with obsessive-compulsive personality disorder will exhibit order in all areas of their lives. 2. Clients with obsessive-compulsive personality disorder will exhibit fear, anxiety, and an excessive need for order. 3. Clients with obsessive-compulsive personality disorder will exhibit the need for perfection in everyone but themselves. 4. Clients with obsessive-compulsive personality disorder will exhibit order in their work lives but are able to relax when away from work.

2

The client states, "I was reared in a chaotic, alcoholic family situation." The nurse knows that the most useful theory for explaining the client's somatoform disorder would come from: 1. Humanistic theory. 2. Psychosocial theory. 3. Biologic theory. 4. Genetic theory.

2

The nurse cares for several clients with somatoform disorders, regularly reassessing their status. The nurse is aware that it is: 1. Easy to be kind, nonjudgmental, and understanding. 2. Challenging because of the psychobiologic factors involved. 3. Best to include objective information only. 4. Best to include subjective information only.

2

The nurse has observed a number of behaviors in the client that indicate that stress management is needed. The behavior the nurse did not observe was: 1. Increased tendency to feel frustrated. 2. Verbalization of feelings. 3. Loss of objectivity. 4. Unnecessary risk-taking.

2

The nurse is caring for a 15-month-old who is admitted to the hospital for the fifth time in six months with severe diarrhea. The patient's mother has been diagnosed with Munchausen by proxy syndrome (MBPS) as she has been giving her child large doses of laxatives to make the child sick. The nurse is having difficulty dealing with the situation. Which of the following is the best way for the nurse to proceed? 1. Confront the mother about making her child sick. 2. Seek clinical supervision to cope with situation. 3. Refuse to take care of the child and family. 4. Have as little contact with the mother as possible.

2

The nurse would teach the adolescent with a conversion disorder what the person "gets" from having the disorder. This explanation would include a discussion of: 1. Preoccupation with the belief that the person has a serious disease without physical evidence. 2. Primary and secondary gains. 3. An overreaction by caregivers to the client's somatic complaints. 4. A pain cure.

2

When working with a client who has exhibited a pattern of violent outbursts followed by remorse, a nurse's plan of care should focus on: 1. Decreasing the client's stressors. 2. Developing effective anger management techniques. 3. Offering the client family counseling. 4. Identifying the client's strengths.

2

Which of the following are risk factors that may continue to promote disequilibrium? 1. Sudden experience, no warning signs 2. Poverty, abuse, pre-existing psychiatric disorder 3. Coping skills, strong self-esteem 4. Communication with others

2

Which of the following combinations of clinical presentations constitutes the most compelling indication that a client may have been abused? 1. Poor eye contact, depressed mood, unwillingness to give history data 2. Multiple bruises and scars, low self-esteem 3. Acting-out behaviors, disobedience, trouble with the law 4. Sores around the mouth, brittle hair

2

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for which of the following? 1. Level of depression 2. Memory impairment 3. Blood pressure 4. Mania

2 These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells

MCSA A client is proud of a recent breakthrough in his ability to control his anger when another client had criticized his behavior. The nurse shakes the client's hand and praises him on his accomplishment. How should this nurse's behavior be interpreted? 1. This gesture is inappropriate because it could seem condescending to the client. 2. This gesture is appropriately timed and suitable in this situation. 3. The use of touch is inappropriate with any client no matter the reason. 4. The use of touch may be perceived as a sexual overture in this situation.

2 Rationale 1: A firm handshake and a statement of congratulations are facilitative in this instance during the working phase of the relationship. The use of touch is appropriate in many instances with many clients if timed and offered correctly. A handshake and congratulatory statement in this situation does not have any sexual or condescending overtones. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship. Question 12

MCSA A client who grew up with alcoholic parents is reluctant to discuss thoughts, feelings, and self-defeating behaviors with the nurse. Which of the following responses by the nurse would be most helpful? 1. "We don't have to talk about your feelings if you don't want to. Let's discuss the behaviors you would like to change." 2. "Some clients who were raised in alcoholic families are reluctant to discuss their feelings. How has this impacted you?" 3. "I understand that you are not used to discussing your feelings; however, we can't continue unless you open up to me." 4. "I understand that opening up to others is difficult for you, but you need to change your view about discussing family issues with me."

2 Rationale 1: Acknowledging the client's reluctance and asking the client to comment on this issue will encourage a dialogue that could lead to the development of further insights. Changing the subject and allowing the client to remain silent about feelings could create a pattern for continued avoidance of feelings. Demanding a change in the client's views or threatening to discontinue the relationship could inhibit the development of a therapeutic alliance. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Establish and maintain one-to-one relationships within the context of the client's cultural background. Question 29

MCSA The correct response of the nurse who is asked if Florence Nightingale had any impact on the role of the nurse in psychiatric-mental health nursing should be which of the following? 1. "No, Nightingale focused her ideas on nursing education rather than direct client care." 2. "Yes, Nightingale was among the first to note that the influence of nurses has psychological components." 3. "No, Nightingale emphasized the physical environment for healing." 4. "Yes, Nightingale developed the idea of the therapeutic relationship."

2 Rationale 1: Although it is true that in the context of her time Nightingale emphasized the physical environment, she did have an impact on psychiatric-mental health nursing. Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components; hence, the value of making her famous evening rounds to say goodnight. Nightingale focused her ideas on both direct client care and nursing education. Hildegard Peplau is credited with theory related to the therapeutic nurse-client relationship. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 17

MCSA Which of the following professionals would be most helpful in providing interdisciplinary supervision regarding specific culture-bound syndromes that interfere with the therapeutic nurse-client relationship? 1. Religious consultant 2. Ethnic consultant 3. Psychologist 4. Psychiatrist

2 Rationale 1: An ethnic consultant can help to evaluate the influence of transcultural issues, including specific culture-bound syndromes. Psychologists, psychiatrists and religious consultants can provide supervision in their respective areas of expertise. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Establish and maintain one-to-one relationships within the context of the client's cultural background.

MCSA An adolescent who is pregnant asks the nurse on the psychiatric unit, "Do you think I should give my baby up for adoption?" Which of the following responses best reflects the nurse's empathy? 1. "Why would you want to give the baby up for adoption?" 2. "What do you feel would be the best thing for you to do?" 3. "It seems you will feel guilty if you gave your baby away." 4. "It would probably be best for you and the baby."

2 Rationale 1: Asking a question that helps the client focus on her feelings conveys the nurse's willingness to be with the client and understand the client's inner experience. Telling the client what would be best is giving advice. Asking the client why she would give up the baby does not convey the nurse's interest in the client's experience and limits therapeutic communication. Telling the client that she will feel guilty assumes an understanding of the client's feelings before the nurse has taken the time to explore the client's experience. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Demonstrate empathy in psychiatric-mental health clinical practice. Question 23

MCSA A nurse has completed orientation to a locked psychiatric unit. Which statement best demonstrates that the nurse is prepared to fulfill the professional role? 1. "I took a course in self-defense so I can take care of myself." 2. "I will ask for support from colleagues when I need it." 3. "I know there is a fine line between the clients and the staff." 4. "I can maintain proper distance by engaging in therapeutic interventions."

2 Rationale 1: Asking for support indicates that the nurse recognizes the emotional challenges of working on a locked psychiatric unit, has engaged in self-reflection, and realizes the value of sharing perceptions, feelings, and concerns with professional colleagues in order to fulfill professional responsibilities. Thinking that one would need a course in self-defense reflects the self-view that the nurse's personal integration is threatened by the environment of the locked unit. Believing that there is a fine line between the clients and staff reveals the nurse has difficulty separating his or her own identity from the client's. Believing that engaging in therapeutic interventions will maintain boundaries indicates a hierarchical perspective of helping others and that the nurse inherently knows how clients should act or feel. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatric-mental health nurses. Question 2

MCSA The nurse finds the client crying in the room. The client states, "I'm so sad and lonely. I'm sitting here crying like a baby." Which of the following responses best reflects the nurse's sensitivity toward the client? 1. "Why don't you come to the dayroom to be with others?" 2. "Are you feeling embarrassed because you are crying?" 3. "Don't worry about crying. I think you are a fine person." 4. "It's a gray, rainy day. A lot of clients are feeling sad."

2 Rationale 1: Asking the client about feeling embarrassed demonstrates the nurse is trying to understand the client's perspective and is showing genuine interest and concern. Telling the client not to worry or suggesting the client be with other clients invalidates the client's experience. Attributing the client's tears to the weather makes an assumption that discounts and invalidates the client's feelings. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 10

MCSA The nurse is in the orientation phase of the nurse-client relationship with the client. Which of the following questions would the nurse commonly ask in this phase? 1. "Which of your behaviors cause you the most problems in relationships with others? 2. "What would you like to accomplish in the time we spend together?" 3. "What is the most satisfying accomplishment you feel you have made in your relationships with others?" 4. "How would you describe your relationships with members of your family?"

2 Rationale 1: Asking the client to identify specific accomplishments to achieve in the therapeutic relationship is a common question to ask during the orientation phase. Asking questions about relationships and problematic behaviors is more appropriate upon entering the working phase, after establishing trust and rapport with the client. Evaluating satisfaction and accomplishments made during the relationship is an important aspect of the termination phase. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 16

MCSA A client states that he is unhappy in his marriage and has felt miserable for several years. Which of the following client responses would indicate that the nurse's response to the "theme" of marital distress was most effective? 1. "I guess you're right; I should start thinking about a divorce." 2. "I feel so depressed all the time. I don't know what to do or who to turn to." 3. "I never thought about her cheating on me before; do you think that's possible?" 4. "I guess we've stayed together all these years because of the children."

2 Rationale 1: By verbalizing his depressed mood and helplessness, the client has been able to effectively identify his feelings in response to the theme of marital distress. Thinking about divorce, possible infidelity, or reasons for staying married are not helpful in assisting the client to identify his feelings in response to the theme of marital distress. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 23

MCSA A female client has made the decision to leave her husband, who abuses alcohol. She states she is very depressed. Which of the following statements best demonstrates the nurse's empathy? 1. "I know you are feeling very depressed right now. I felt the same way when I left my husband. From my experience, you are doing the right thing." 2. "I can understand that you are feeling depressed right now. It must have been a very difficult decision to make. I'll sit here with you for a while." 3. "I am very sorry you are going through this difficult time. I wish things could be different." 4. "It is sad thing to break up a marriage. It's a shame that it didn't work out for you."

2 Rationale 1: Conveying an understanding of the client's feelings, acknowledging the difficulty of the decision, and offering to sit with her conveys the nurse's ability to respond to and understand the experience of the client on her terms. Self-disclosure of the nurse's experience to validate the client's experience does not convey empathy and may overwhelm the client. Saying you are sorry and wishing things could be different conveys sympathy, not empathy. Saying that it is a sad situation and that it is a shame it did not work out invalidates the client's experience and shuts down expression of feelings. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Demonstrate empathy in psychiatric-mental health clinical practice. Question 22

MCSA The nurse is reflecting on psychiatric nursing care in the 19th century. Which nursing diagnosis is most consistent with the focus of psychiatric nursing care during the 19th century? 1. Ineffective individual coping 2. Self-care deficit 3. Anxiety 4. Altered thought processes

2 Rationale 1: During the 19th century, psychiatric nurses attended mainly to the physical needs of clients and did not pursue systematic interpersonal work with them. Psychiatric nursing practice was primarily custodial. Nursing care that systematically addresses anxiety, coping, and altered-thought processes did not come about until the mid 20th century. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 19

MCSA A client comes to the nurse's station yelling, "I have to call the FBI. The bombs are set to destroy Washington, D.C. at 1:00 p.m. Please help me. It will be your fault if I don't call." Which intervention best demonstrates the nurse's sensitivity? 1. Assist the client to become aware that this is a delusional belief. 2. Listen carefully for the underlying emotion expressed by the client's request. 3. Share your concerns that the client's request is unreasonable. 4. Switch the topic of conversation to defuse the client's underlying agitation.

2 Rationale 1: Listening for the tone underlying the client's request, rather than responding to the actual request, demonstrates the nurse's sincerity and non-defensive approach to the client. Switching topics breaks down communication. Believing the client's request is unreasonable or identifying the belief as delusional invalidates the client's feelings and reflects insensitivity to the client's concern. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 8

MCSA A nurse is seeking consultation on strategies to cope with the potential for burnout while working on a psychiatric unit. Which of the following strategies demonstrates the nurse's ability to reduce the occurrence of burnout? 1. Focus on paperwork when the stress of listening to the clients becomes too much. 2. Pursue personal needs for social interactions during days off. 3. Take breaks often to relieve internal stress signals. 4. Maintain an accurate awareness of each client's needs throughout inpatient stays.

2 Rationale 1: Nurses who recognize that personal needs are an integral part of professional practice will be able to maintain concern and feeling for their clients. Maintaining an accurate awareness of client needs is not realistic and implies that the nurse can provide perfect care. Nurses who focus on paperwork tend to cope with stress by distancing themselves from the clients. Taking frequent breaks is an attempt to escape from one's stress rather than attend to it. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others. Question 30

MCSA The nurse is writing a care plan for a client with schizophrenia. Which of the following interventions demonstrates that the nurse is working from the Medical model? 1. The nurse will ask the client to identify responsible ways to manage delusional material. 2. The client will learn about the therapeutic effects of medications. 3. The nurse will teach the client appropriate social behaviors in group and one-on-one interactions. 4. The client will learn techniques that will interrupt hallucinations.

2 Rationale 1: The nurse who provides teaching to the client about medications is operating from the model that schizophrenia is a neurobiological disorder over which the client has no control, but can take responsibility for the symptoms by learning about medications. The nurse who teaches the client techniques to interrupt hallucinations operates from the model that the client is not to be blamed for the hallucinations but can take steps to manage the symptoms. The nurse who believes that teaching the client appropriate social behaviors is operating from the model that the client is responsible for inappropriate social behaviors and needs assistance from the nurse to solve this issue. The nurse who believes that asking the client to identify responsible ways to manage delusional material is operating from the model that the clients cause their own problems and are responsible for developing solutions. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice. Question 15

MCSA The client on the psychiatric unit is asking questions about prevention of sexually transmitted diseases. Given the Psychiatric-Mental Health Nursing Standards of Practice, which action would be most appropriate for the nurse to take at this time? 1. Consult with the mental health care team. 2. Teach safer sexual practices. 3. Investigate the questions in individual psychotherapy. 4. Notify the attending psychiatrist.

2 Rationale 1: The psychiatric-mental health nurse employs strategies to promote health and a safe environment and teaches safer sexual practices to the client who is asking for the information. Notifying the psychiatrist and consulting with the mental health care team is not necessary as health teaching is within the independent practice of the RN. Conducting individual psychotherapy is not within the practice standards for the generalist nurse. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatric-mental health nursing. Question 6

MCSA The client asks the nurse if certain changes can be made in the unit milieu. Which action by the nurse indicates understanding of the nursing role in the therapeutic milieu? 1. The nurse refers the client's requests to the psychiatric social worker. 2. The nurse discusses the desired changes with the client. 3. The nurse refers the client's requests to the psychosocial rehabilitation worker. 4. The nurse instructs the client that no changes can be made.

2 Rationale 1: The psychiatric-mental health nurse has major responsibility for the milieu; therefore, it is appropriate to discuss requested changes in order to gather information regarding the effectiveness of the milieu. The psychiatric social worker identifies community resources and may perform counseling. It is non-therapeutic to instruct the client that no changes can be made before gathering data in relation to the client's requests. The psychosocial rehabilitation worker teaches day-to-day skills for living and may provide case management services. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatric-mental health nurse and other members of the mental health team. Question 7

MCSA On which dimension would the nurse most likely focus data collection if the nurse was assessing the client from primarily a 19th century perspective? 1. Spiritual 2. Physical 3. Social 4. Emotional

2 Rationale 1: Up until the early to mid-20th century, psychiatric nurses attended primarily to the physical needs of the clients and did not pursue interpersonal work with them. Psychiatric nursing care during this period emphasized a physical environment that would promote recovery. More holistic care (including emotional-social-spiritual dimensions) is a product of more recent history. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 20

MCSA The psychiatric-mental health nurse is asked to develop an intervention for the nursing unit based on Watson's theory of caring. Given this assignment, which intervention is most appropriate for the nurse to implement? 1. One-to-one debriefing sessions each week with individual unit nurses and the unit manager 2. Clarification of values and cultural beliefs that might pose barriers to caring for clients 3. Identification of additional coping skills for new nurses on the unit 4. Discussion of the impact of recent changes in hospital policy on the nursing staff

2 Rationale 1: Watson's theory of human caring emphasizes sensitivity to self and values clarification regarding personal and cultural beliefs that might pose barriers to transpersonal caring. Identification of coping skills for new nurses is consistent with Roy's theory of adaptation. Discussion of the impact of change on the nursing staff is consistent with Rogers's theory that considers humans and environmental interactions and change. One-to-one debriefing sessions are more consistent with Peplau's theory; however, this intervention could be used in a variety of theoretical approaches. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatric-mental health nursing most directly. Question 26

MCSA The nurse is researching statistics of the five psychiatric disorders that comprise the top 10 causes of disability worldwide. Given this information, the nurse chooses which of the following as a priority screening for clients? 1. Bipolar disorder 2. Depression 3. Schizophrenia 4. Alcohol abuse

2 Rationale 1: Within the Global Burden of Disease study, depression ranked number one among the five psychiatric disorders included in the top 10 causes of disability worldwide. Other disorders on the top 10 list were schizophrenia, bipolar disorder, alcohol abuse, and obsessive-compulsive disorder. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 15

MCMA A client familiar to the nurse is grief-stricken and in tears after learning that his wife has decided to file for divorce and sue for full custody of their children. Which of the following actions by the nurse are appropriate? Standard Text: Select all that apply. 1. Wiping away the client's tears without permission 2. Asking the client if it is okay to give him a hug 3. Holding the client's hand with his permission 4. Patting the client on the shoulder and offering reassurance

2,3 Rationale 1: Holding the client's hand with his permission is appropriate and can foster a more productive therapeutic relationship. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship. Question 13

MCMA The nurse is working with a client who has demonstrated an unwillingness to change self-defeating behaviors. The nurse determines that the patient is exhibiting resistance. Which of the following phenomena are forms of client resistance? Standard Text: Select all that apply. 1. Overdisclosure 2. Negative transference 3. Acting-out 4. Countertransference 5. Positive transference

2,3 Rationale 1: Overdisclosure. Overdisclosure refers to an excessive amount of self-disclosure by the nurse that can overwhelm and engulf the client. Overdisclosure can impede therapeutic progress, especially with clients who have poor ego boundaries, but it is not a form of client resistance. Rationale 2: Negative transference. When a client displays hostility, loathing, bitterness, contempt, and annoyance toward the nurse, the therapeutic process is impeded. Rationale 3: Acting-out. Displaying inappropriate behavior or "acting out" a memory that was forgotten or repressed is a particularly destructive form of client resistance. Rationale 4: Countertransference. Countertransference involves the nurse's inappropriate reaction to the client and is not a form of client resistance. Rationale 5: Positive transference. Positive feelings of the client toward the therapist due, in part, to past relationships with significant others, can help to facilitate therapeutic progress. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Encourage the client's systematic use of abilities and behaviors most often associated with growth-producing outcomes. Question 8

The nurse is working with a family that has just survived a tornado. As part of the intervention, the nurse is reviewing emotions they may be experiencing which are considered normal reactions to a traumatic event, including: Standard Text: Select all that apply. 1. Each family member talks to the nurse openly and freely. 2. Each member of the family has different ways of coping. 3. Some family members have difficulty accepting help. 4. Anxiety about self and family's safety. 5. All family members will process the experience at about the same pace.

2,3,4

Communication intervention strategies are significant for the nurse to utilize. These techniques include: Standard Text: Select all that apply. 1. Personal revelations about the nurse's feelings to "break the ice." 2. Reflecting statements that encourage the client to express feelings. 3. Paraphrasing client statements using clinical terms. 4. Statements that promote expression of the client's emotions. 5. Clarifying statements the client has made.

2,4,5

MCMA The nurse is explaining the nurse-client relationship to a client in their first formal counseling session. Which of the following characteristics should the nurse describe as part of this one-to-one relationship? Standard Text: Select all that apply. 1. Sympathetic 2. Shared dignity 3. Harmonious 4. Mutually defined 5. Goal directed

2,4,5 Rationale 1: Sympathetic. The nurse is expected to be caring and empathetic, but should not let personal feelings interfere with objectivity and the ability to help the client cope effectively. Rationale 2: Shared dignity. The nurse encourages clients to share freely and openly in an atmosphere of mutual respect and courtesy. Rationale 3: Harmonious. Nurses and clients may not always be in agreement, particularly if clients do not accept responsibility for their actions. Resistance may be present in one-to-one relationships when clients struggle against change. Rationale 4: Mutually defined. The terms under which the relationship is to evolve are equally determined by nurse and client and require the commitment of both parties. Rationale 5: Goal directed. The client is expected to identify and work toward specific objectives within the context of the therapeutic relationship. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain the common shared characteristics of one-to-one relationships. Question 5

MCMA The psychiatric nurse states that today's nursing practice is based on contemporary theories concerning the etiology of mental disorder. Given this theoretical basis, the nurse would most likely give priority to which of the following assessments? Standard Text: Select all that apply. 1. Family communication patterns 2. Psychotropic medications 3. Family history of mental disorder 4. Early childhood interactions 5. PET and CT scans of the brain

2,5 Rationale 1: Family communication patterns are more consistent with the psychological theories consistent with the era of psychoanalysis. Rationale 2: Psychotropic medications: Psychotropic medications alter brain neurotransmitters, which is consistent with the reconceptualization of the diagnosis and treatment of mental disorders. Rationale 3: Family history of mental disorder: The interrelationship between genetics and mental disorder is identified as an area for current and future research. Rationale 4: Early childhood interactions are more consistent with earlier psychological theories of mental disorder. Rationale 5: PET and CT scans of the brain: Researchers have linked a number of mental disorders to brain dysfunction, which is consistent with current theories. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Question 25

MCMA The nurse is planning activities to enhance collaboration within the mental health care team. Which activities will be helpful toward this goal? Standard Text: Select all that apply. 1. Identification of ways to minimize diversity among team members 2. Discussion of decisions that require team unity 3. Identification of ways to ignore individual power bases 4. Review of interpersonal communication skills 5. Discussion of decisions that can be made autonomously

2,5 Rationale 1: Identification of ways to minimize diversity among team members. Effective collaboration on a team involves the ability to value diversity and turn differences into assets. An inability to value diversity may be a detriment to the team's efforts. Rationale 2: Discussion of decisions that require team unity. Unity should be balanced with autonomy. Identification of parameters for nursing collaboration would be useful toward the goal. Rationale 3: Identification of ways to ignore individual power bases. Team members should recognize rather than ignore personal power bases and share power with others. Ignoring this element may decrease the effectiveness of collaboration. Rationale 4: Review of interpersonal communication skills. Effective communication and processing skills will enhance effective collaboration. Rationale 5: Discussion of decisions that can be made autonomously. Unity should be balanced with autonomy. Collaboration is not required for all decisions. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others. Question 15

*What is the onset of action for Buspirone?

2-4 weeks

A nurse ac knowledges feeling anxious about meeting new people. By acknowledging feelings to the client, the nurse is demonstrating: 1. Sympathy 2. Genuineness 3. Empathy 4. Superficiality

2. Genuineness

A client states that she has a plan to commit suicide. The priority assessment at this time is the: 1. Client's educational and economic background. 2. Lethality of method and availability of means. 3. Quality of the client's social support. 4. Client's insight into the reasons for her decision.

2. Lethality of method and availability of means.

Age range of the Intimacy vs. Isolation stage of Erikson's theory

21 to 39 yrs (young adult)

A client is being seen in the clinic for right-hand paresthesia that the client does not seem to be overly concerned about. The condition developed abruptly after being caught cheating on an exam by the teacher. The paresthesia also ended abruptly as well. Which symptom most clearly relates to la belle indifférence? 1. Being caught cheating on the exam 2. Right-hand paresthesia 3. Lack of concern over the paresthesia 4. Paresthesia beginning and ending abruptly

3

A client is certain she has cancer and peritonitis despite her doctor's reassurance she does not. She most likely is experiencing: 1. Malingering. 2. Conversion disorder. 3. Hypochondriasis. 4. Factitious disorder.

3

A client with a diagnosis of paranoid personality disorder appears hypervigilant and sits alone in an isolated area of the unit. The client does not acknowledge other clients and often uses sarcasm when addressing staff. The nurse invites the client to attend a milieu group, but the client ignores the nurse's efforts. An appropriate nursing diagnosis for this client is which of the following? 1. Activity Intolerance 2. Fear 3. Impaired Social Interaction 4. Powerlessness

3

A client, divorced for one year, has recently had crisis counseling. The client has begun to take classes at the community college and has enrolled the children in day care. These new actions could be referred to as: 1. A response to stress. 2. A situational crisis. 3. A turning point in life. 4. A maturational crisis.

3

A new nurse feels that it is hopeless to provide sexual and physical abuse victims with community resources when most of them choose to go back and live with their abusers. What would be an appropriate response by the counselor? 1. "Some of these clients don't know any better." 2. "We are mandated by law to give clients information on resources prior to discharge." 3. "It is important to empower clients and help them see that they can make positive changes." 4. "Sometimes things do improve at home."

3

A nurse is working with a client who has a diagnosis of obsessive-compulsive personality disorder. It is important for the nurse and client to discuss: 1. The effect of anger on perfectionism. 2. The need to feel superior. 3. The link between anxiety and perfectionism. 4. The need for medication.

3

A nurse working with clients affected by a disaster event must be conscious not only of the clients' responses, but also the nurse's own responses. Which of the following would not be a common experience? 1. Not wanting to leave the scene until work is finished 2. Denying the need for rest and recovery time 3. Inability to engage in problem solving 4. Profound sadness, grief, and anger toward an abnormal event

3

A victim of sexual abuse expresses the belief to the nurse that the abuse is a punishment for not having lived a spiritually pure life prior to the event. The nurse: 1. Indicates to the victim that this is an incorrect view. 2. Makes it clear to the client that the rape was not a punishment for the client's own behavior. 3. Acknowledges the client's spiritual frustration and invites the client to express these feelings. 4. Explains that rape can happen even to the most religious people.

3

An 18-year-old client who joined the military shortly after graduating from high school is admitted to the mental health unit for depression and suicidal ideation. He tells the nurse the military is not what he expected and he wants to go home. The nurse observes a variance in affect between his interaction with peers and staff. The nurse suspects: 1. Conversion disorder. 2. Factitious disorder. 3. Malingering. 4. Body dysmorphic disorder.

3

Balancing factors that help clients after a crisis would not include: 1. Degree of threat to life. 2. Realistic perception of the event. 3. Decreased or limited communication. 4. Adequate coping mechanisms.

3

Effective planning for a client's crisis intervention is: 1. Organized with follow-up. 2. Developed prior to meeting with the client. 3. Based on complete assessment. 4. Focused on long-term problems.

3

In assessing a client who has suffered domestic violence, the nurse observes that the client is regressing back to childhood, is having difficulty trusting the nurse, is expressing rage and grief, and is talking about how unfair God has been and wondering why God has been "so insensitive." Based on these observations, what would be the most appropriate plan of action for the nurse? 1. Suggest that the client join a survivor support group. 2. Encourage the client to attend religious activities at the local church. 3. Refer the client to a religious counselor. 4. Explain to the client that God has his own reasons that most of us do not understand.

3

In describing personality disorders to a group of consumers, which statement by the nurse is accurate? 1. "People with personality disorders are unable to experience painful feelings." 2. "These disorders usually develop during the toddler stage." 3. "People with personality disorders view their problems as separate from themselves." 4. "Behavior is sporadic with no particular pattern."

3

One of the following statements regarding crises is incorrect. Identify the incorrect statement. 1. A maturational crisis involves life cycle changes or transitions of human development. 2. A situational crisis can originate from material, environmental, or personal sources. 3. Experiencing a crisis always develops into post-traumatic stress disorder. 4. A crisis is an acute time-limited state of disequilibrium.

3

The client states that she has been ill and in pain since childhood. Her many symptoms are not caused intentionally, nor are they feigned. She has seen many doctors. Consistent with this client's disorder, the nurse believes the pain the client experiences is: 1. Fake. 2. Exaggerated. 3. Real. 4. For attention.

3

The nurse finds that the client with a somatoform disorder has physical symptoms, but there is no evidence of physiologic disease. The client may have decreased amounts of serotonin and endorphins, causing the client to experience an increased sensitivity to pain. This explanation of the client's symptoms is based in: 1. Communication theory. 2. Humanistic theory. 3. Biologic theory. 4. Genetic theory.

3

The nurse is caring for a client with a history of admissions to several hospitals over the last several years. Each hospitalization was for a different disorder in which there was no physical evidence. The medical record indicates the client is a pathological liar. Which of the following disorders does the client suffer from? 1. A somatoform disorder 2. Factitious disorder by proxy 3. Adult factitious disorder 4. Dissociative identity disorder

3

The nurse is caring for a client with schizoid personality disorder. Which nursing diagnosis is most appropriate for this client with a cluster A personality disorder? 1. Fear related to feelings of abandonment 2. High Risk for Violence, Self-Directed, related to poor impulse control 3. Social Isolation related to inadequate social skills, craving of solitude 4. Ineffective Individual Coping related to high dependency needs

3

The nurse is working with a client who exhibits a pervasive, excessive, and unrealistic need to receive care. This client's behavior is a characteristic of which of the following personality disorders? 1. Histrionic personality disorder 2. Narcissistic personality disorder 3. Dependent personality disorder 4. Avoidant personality disorder

3

The nurse is working with a client who has a history of impulsive and self-harming behavior. The nurse will need to address which of the following in the plan of care? 1. Boundary setting 2. Confidentiality 3. Safety 4. Appropriate self-disclosure

3

The nurse is working with a client who has been diagnosed with a personality disorder. Which situation best describes the client's external response to stress? 1. The client attends group therapy. 2. The client uses meditation when upset. 3. The client tries to change the environment instead of changing him- or herself. 4. The client engages in self-awareness exercises.

3

The nurse is working with a client who is being admitted to the psychiatric-mental health unit. The client was missing for two weeks and returned home not knowing any time had passed. Which of the following dissociative disorders has this client experienced? 1. Amnesia 2. Depersonalization disorder 3. Fugue 4. Dissociative identity disorder (DID)

3

The nurse understands that the underlying issue of most abusers is: 1. An uncontrollably urge to love. 2. The inability to control intense anxiety. 3. A desire to enslave and control. 4. A desire to play out fantasies.

3

When working with clients with somatoform disorders, the nurse knows the priority intervention is to: 1. Encourage clients to participate in group therapy to receive feedback about the effect of their behavior on others. 2. Tone down clients' characteristic extravagance. 3. Establish a trusting relationship. 4. Express respectful skepticism regarding clients' oversimplifications and overdramatizations.

3

Which statement by a client would suggest that the ABCs of crisis counseling have been met? 1. "I am really glad we did this counseling." 2. "I will call you if I need you." 3. "I now know some better ways of coping." 4. "I will miss working with you."

3

MCSA The nurse is teaching a group of students the various historical explanations of mental illness. Which statement by the students indicates understanding of the nurse's teaching regarding the era of magico-religious explanations? 1. "The insane were believed to be divinely inspired and care was generally benevolent and kindly." 2. "Mental illnesses were caused by imbalances in body humors: blood, bile, and phlegm." 3. "Mental and physical illness were the result of superhuman forces that inflicted suffering." 4. "Mental illnesses were influenced by the moon; hence, the term lunacy."

3 Rationale 1: "The insane were believed to be divinely inspired and care was generally benevolent and kindly." This statement expresses Arab social and philosophical beliefs. The insane were believed to be divinely inspired and were cared for in a benevolent and kindly manner. Rationale 2: "Mental illnesses were caused by imbalances in body humors: blood, bile, and phlegm." This statement is from the era of organic explanations. Hippocrates postulated that mental illnesses were caused mainly by imbalances in body humors: blood, bile, phlegm. Rationale 3: "Mental and physical illness were the result of superhuman forces that inflicted suffering." This is an explanation from the magico-religious era. Rationale 4: "Mental illnesses were influenced by the moon; hence, the term lunacy." This statement is from the era of alienation, Middle Ages and The Renaissance. Mental illnesses were thought to be influenced by the moon; hence, the term lunacy. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Question 21

MCSA The nurse is teaching staff at a community mental health clinic about what constitutes a mental disorder. Which comment by staff indicates to the nurse the need for further teaching? 1. "Experiencing distressful symptoms may imply a mental disorder." 2. "Experiencing pain and suffering may imply a mental disorder." 3. "Being unable to function in everyday life is consistent with a mental disorder." 4. "Grieving after a loss may signal a mental disorder."

3 Rationale 1: A mental disorder is a psychological group of symptoms in which an individual experiences distress, or impairment in one or more areas of functioning, or a significant increased risk of suffering, pain, loss of freedom, or death. Grieving after a loss is a normal grief response and does not constitute a mental disorder. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Define and explain mental disorder. Question 7

MCSA The charge nurse has just given a presentation about the importance of practicing self-care. Which of the following staff behaviors will the nurse find concerning? 1. Giving feedback to a fellow staff member about derogatory comments 2. Requesting to be alone during break time 3. Calling the unit on days off to inquire about clients' progress 4. Verbalizing feelings about a client's situation

3 Rationale 1: A nurse who feels compelled to check on clients during sanctioned time away is unable to leave concerns about the clients at work and cannot assimilate the experiences of working with troubled clients. Requesting to be alone during break time demonstrates the nurse's need for self-care after responding to the needs of clients. Providing feedback to another staff member demonstrates accountability for the quality of care and confronts demeaning language. Verbalizing one's feelings enhances self-awareness of difficult emotions and allows for constructive feedback and new perspectives. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Demonstrate a commitment to practicing self-care and connecting with self and others.

MCSA The nurse has been working with a depressed client for several months. Which of the following signs would indicate that an ineffective working relationship has evolved between the client and the nurse? 1. The client's sense of relaxation and confidence with the nurse 2. The nurse's and client's sense of commitment to addressing the client's problems 3. The nurse's sense of the client's severe dysfunction that cannot result in client growth 4. The nurse's sense of making contact with the client

3 Rationale 1: A sense that the nurse cannot facilitate client growth due to severe client dysfunction indicates that a working relationship has not evolved effectively. The sense that the nurse has made contact with the client and is committed to addressing the client's problem is a sign of an effective working relationship. The sense that the client is relaxed and confident with the nurse's abilities also indicates an effective working relationship. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 24

MCSA The nurse is caring for a client who was recently admitted to the unit. During the nursing assessment of the client, the nurse finds the client's beliefs and actions related to many health practices to stray from the norm. Which action would be most appropriate for the nurse to take at this time? 1. Repeat the assessment later in the day. 2. Write a nursing diagnosis to address the "bizarre" beliefs and actions. 3. Inquire as to the culture with which the client identifies. 4. Communicate the findings to the health care team.

3 Rationale 1: A thorough assessment is needed before proceeding with other steps of the nursing process. Behavior that is considered bizarre in one cultural context may be considered desirable in another. While findings will be communicated and used for nursing diagnosis formulation, these steps are built upon a thorough assessment. Repeating the assessment will most likely result in the same incomplete data. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze why the term "deviant behavior" lacks a definition that covers all situations. Question 10

MCSA A nurse is working with a client who was admitted for treatment of bipolar disorder. The client asks the nurse if it is "OK" to pray for recovery. Which response best conveys the nurse's ability to be a spiritual activist for the client? 1. "Clients in psychiatric hospitals often experience spiritual crises that require prayer." 2. "It's acceptable for clients to pray in the hospital chapel." 3. "Spiritual practices, such as praying, can nurture one's spirit and enhance healing." 4. "It's not advisable to focus only on prayer as a means to recovery."

3 Rationale 1: Acknowledging that a client's spiritual practices may assist in recovery acknowledges that practice of a religious or spiritual ritual is a reflection of the client's connection to faith. Telling the client that it is acceptable to pray in the hospital chapel ignores the client's question about the meaning of prayer. Suggesting that it is not advisable to focus only on prayer invalidates the client's spiritual needs. Generalizing about clients experiencing spiritual crises because of their hospitalization minimizes the importance of the client's search for meaning. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 14

MCSA The nurse has just received a report on a new client admitted for depression. The client has severe cerebral palsy, communicates only with a computer, and is quadriplegic. Which of the following statements best demonstrates that the nurse has the ability to respond to this client? 1. "I will read the record and talk with the physician to understand the client's disabilities." 2. "It is important to interview the client's family before I meet the client." 3. "This assignment may be a challenge for me and I will need to be aware of my feelings and any potential fears related to caring for this client." 4. "The first thing I will do is thoroughly assess the client's needs and abilities."

3 Rationale 1: Acknowledging that caring for the client may be a challenge is the correct answer. Self-awareness of one's feelings and potential emotional responses to a situation is essential to develop empathy. The nurse recognizes that before meeting any client, it is important to recognize one's feelings and clarify beliefs and attitudes, especially when receiving medical information that might be unusual or even frightening. Assessing the client's needs and abilities and interviewing the family may be helpful in caring for this client, but will not necessarily enhance the nurse's self-awareness. Reading the record and talking with the physician demonstrates that the nurse has difficulty confronting feelings and will rely on others for guidance. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain how self-knowledge and self-reflection are important to psychiatric-mental health nurses. Question 4

MCSA The nurse plans to implement health promotion activities at the local senior citizen center. To meet the goal of promoting knowledge related to maximizing mental health and functional ability, the nurse's teaching is guided by World Health Organization research and should include discussion of which priority area specific to the leading causes of mental disability? 1. Social isolation 2. Dementia 3. Alcohol 4. Over-the-counter medications

3 Rationale 1: Alcohol use is the 4th leading cause of mental disability and produces greater decrement in worldwide mental ability when compared with dementia, social isolation, or use of over-the-counter medications. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 17

MCSA The client says to the nurse, "It's my right to refuse medications." Which statement best reflects the nurse's ability to create a mutual understanding? 1. "Refusing your medications is your right, but it won't get you out of here." 2. "Can you tell me why you're so angry that you will refuse your medications?" 3. "Can you tell me what concerns you have about medications?" 4. "If you refuse your medications, you will just get sick again."

3 Rationale 1: Asking the client to clarify concerns about medications shows that the nurse recognizes the client's goals may be different from the nurse's. Telling the client that refusing medications will result in getting ill or prevent discharge conveys that the nurse is threatened by the client's assertiveness. Interpreting that the client is angry suggests that the nurse is making assumptions about the client's refusal, rather than operating on the facts. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatric-mental health nursing practice. Question 7

MCSA A woman has been living in a shelter with her children after escaping her abusive husband. Her move-out date is getting closer. She states, "I'm afraid to leave here. I'm afraid for my safety and the safety of my children." Which response by the nurse most accurately conveys empathy? 1. "Even though you are scared, it's the policy that you have to leave. It's unfortunate, but there's nothing I can do." 2. "We learned your husband has moved out of state. I don't think you have anything to worry about now." 3. "This is a difficult and scary transition. Let's work on developing a plan to keep you and your family safe." 4. "You've had a month to come up with a plan for keeping you and your family safe. Let's review your options."

3 Rationale 1: By responding to the client's feelings and offering assistance, the nurse demonstrates an understanding of the client's need for safety and security. Acknowledging the client's fear and then changing the focus to policy invalidates the client's experience. Telling the client that she has already had a month to work on a plan and offering to review the options conveys a judgmental attitude toward the client. Telling the client not to worry because her husband has left the state offers false reassurance and negates the client's feelings. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Demonstrate empathy in psychiatric-mental health clinical practice. Question 24

MCSA The nurse is admitting a client to the psychiatric unit. Which nursing action is correct? 1. Instruct the client that all information gathered during the assessment will be shared with the mental health team. 2. Alert the client that the psychiatrist will do all the intake assessment to maximize the efficiency of the team. 3. Discuss with the client information that is to be shared with family members and the mental health team. 4. Instruct the client that the mental health team will decide what the client needs to do in treatment.

3 Rationale 1: Discussing with the client information that is to be shared with family members and the mental health team is an action that promotes a partnership with the client and enhances effectiveness of treatment. The nurse should communicate to the client that decisions related to the sharing of information would take into consideration any agreement regarding disclosure that exists between the nurse and the client and how the receiving party will use the information in the client's best interest. Not all information is significant to the client's reason for treatment. The nurse should communicate circumstances where significant information will be shared. In the spirit of collaboration, the mental health team should involve the client. This assures that clients are informed consumers of mental health services. While the psychiatrist will assess the client from the medical perspective, the nurse must assess the client's responses to the mental disorder in order to plan appropriate nursing care. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others. Question 16

MCSA The nurse suspects a client is unwilling to demonstrate self-sufficiency or independence in the therapeutic relationship when the client says, "You are the only person I can talk to or trust. Let's go out to dinner tonight so we can spend more time together." Which one of the following nurse responses is most appropriate in this situation? 1. "I sense we are beginning to make real progress; I think that's a great idea." 2. "Maybe some other time, but right now I'm involved in a significant relationship and don't feel right about meeting you for dinner." 3. "I sense you've become too dependent on this relationship; let's examine your feelings toward me." 4. "You've become too dependent on me, so I will have to terminate our relationship."

3 Rationale 1: Examining a client's feelings toward the nurse brings the inappropriate behavior to the attention of the client and is an appropriate way to deal with this acting-out behavior. Although increasing the frequency of contacts in the professional setting is appropriate, agreeing to meet the client socially is inappropriate and could encourage further dependency. Terminating the relationship is unnecessary unless repeated dangerous acting-out behavior occurs. Suggesting that the nurse would meet the client socially if not for involvement in a significant relationship may encourage further dependency and foster the client's mistaken expectation that a relationship might be possible in the future. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Encourage the client's systematic use of abilities and behaviors most often associated with growth-producing outcomes. Question 7

MCSA During the evaluation of the effectiveness of the nurse's discharge teaching, which client report would indicate to the nurse that the client understands the leading cause of disability and decrement in health? The client reports a need to incorporate strategies to prevent: 1. Obesity. 2. Anxiety. 3. Depression. 4. Cancer.

3 Rationale 1: Given World Health Organization (WHO) research, depression is the leading cause of disability in people ages 15 and older and produces the greatest decrement in health when compared to anxiety and chronic physical diseases, which include cancer and obesity. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 19

MCSA The nurse planning a brief presentation about the "first American psychiatric nurse" will research which of the following? 1. Hildegard Peplau 2. Harriet Bailey 3. Linda Richards 4. Gwen Tudor (Will)

3 Rationale 1: Linda Richards, "the first American psychiatric nurse," opened the first American school for psychiatric nurses and spent a significant part of her career developing better nursing care in psychiatric hospitals. Hildegard Peplau developed the first systematic theoretic framework in psychiatric nursing. Harriet Bailey wrote the first psychiatric nursing text, Nursing Mental Diseases. Gwen Tudor (Will) was the first nurse to publish an article in the journal Psychiatry. While the last three nurses made significant contributions, the title of "first American psychiatric nurse," falls to Linda Richards. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 18

MCSA The psychiatric mental health nursing student is preparing to attend a meeting of the psychiatric mental health care team to discuss possible updates to clients' diagnoses. In preparing for this meeting, the nursing student should consult which of the following references? 1. Standards of Psychiatric Nursing Practice 2. Psychiatric nursing care plan manual 3. Diagnostic and Statistical Manual of Mental Disorders 4. Dictionary of common mental disorders

3 Rationale 1: Mental disorders are identified, standardized, and categorized in the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association (APA). All members of the health care team use this reference. A psychiatric nursing care plan manual is a reference for nursing care and a dictionary will offer only a general definition. Standards of Psychiatric Nursing Practice outlines nursing responsibilities, but does not apply to clients or other members of the multidisciplinary health care team. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Define and explain mental disorder. Question 3

MCSA The nurse is planning care for a new patient admitted to the behavioral health unit. Which of the following activities can the nurse expect to occur in the orientation phase of a therapeutic nurse-client relationship? 1. Explore in-depth how the client relates to others. 2. Emphasize growth and positive aspects of the relationship. 3. Discuss with the client how to work together toward a common goal. 4. Identify dysfunctional client thoughts and emotional patterns.

3 Rationale 1: Mutual goal-setting is a common activity in the orientation or beginning phase to delineate the client's expectations and the nurse's responsibilities in a therapeutic alliance. In-depth exploration of relationships and the identification of dysfunctional thoughts and emotions commonly occur in the working or middle phase of the relationship. The emphasis of growth and positive aspects of the relationship is the goal of the termination or end phase. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 15

MCSA During the initial interview with a client, the nurse notices that the client changes the topic when the subject of the client's marital relationship is approached. The nurse is guided by the knowledge of which of the following? 1. Discussion of sensitive issues should only occur in the working phase. 2. Formulation of nursing diagnoses should be avoided until all essential data is obtained. 3. Information that is avoided or omitted is often more crucial than what is shared. 4. Avoidance of a topic is a sign of resistance that will disappear when initial anxiety is decreased.

3 Rationale 1: Observation is essential to clinical practice, particularly in one-to-one relationships. Non-verbal behavior and missing information can indicate an area that requires further exploration. Sensitive issues can be discussed in all phases of the therapeutic relationship, particularly if it is valuable in providing direction for nursing care. A preliminary nursing diagnosis should be formulated based on dominant themes or central issues that may be revised as client behaviors unfold during the course of the one-to-one relationship. Resistive behaviors do not commonly disappear on their own and must be addressed openly for the therapeutic nurse-client relationship to progress. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 21

MCSA The nurse educator is teaching a group of students about the phases of the nurse-client relationship. Which of the following objectives does the educator include as indicative of the working phase of the nurse-client relationship? 1. Client accomplishments are honestly evaluated. 2. Plans for follow-up are clearly arranged. 3. Client behaviors and response patterns are openly analyzed. 4. Roles and responsibilities of the client are explicitly defined.

3 Rationale 1: Open analysis of client behaviors and response patterns is one of the primary objectives during the working phase. Evaluating client accomplishments and arranging for follow-up are aspects of the termination phase. Explicit definition of client roles and responsibilities is an important aspect of the orientation phase. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 18

MCSA If psychiatric nurses used Orem's theory for structuring much of their nursing practice, a major focus area for assessment would be the client's ability to do which of the following? 1. Adapt and function to meet various role expectations. 2. Care about self and participate in self-healing. 3. Implement self-care to meet psychosocial needs. 4. Enter into a therapeutic one-to-one relationship with the nurse.

3 Rationale 1: Orem's theory of self-care identifies universal self-care requisites and categories that encompass both physical and psychosocial human needs. Orem focuses on abilities to perform self-care to maintain life, health, and well-being. Peplau conceptualizes the one-to-one nurse-client relationship. Roy's adaptation theory identifies modes of human adapting, including the area of role function. Watson's theory of human caring emphasizes self-caring and self-healing. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatric-mental health nursing most directly. Question 25

MCSA The nurse is planning care for an Asian client who is Buddhist. Which of the following actions is most important for the nurse to take to provide culturally relevant mental health care? 1. Explain western medical ideas to assist cultural adaptation. 2. Develop a thorough understanding of Buddhist religion. 3. Seek clarification of this client's health beliefs. 4. Use standard nursing interventions for this client.

3 Rationale 1: Seeking clarification of this client's health beliefs demonstrates that the nurse recognizes that a client's cultural beliefs can affect the client's response to treatment. Although developing a thorough understanding of Buddhist religion will assist the nurse in providing culturally competent care, it is not always possible to do so before encountering a client who is Buddhist. Explaining western medical ideas or using standard nursing interventions will not assist the nurse in delivering culturally competent care. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice. Question 20

MCSA The psychiatric nurse is reflecting on the treatment and care of the mentally ill throughout history. Which of the following philosophical beliefs most guided treatment of the mentally ill during 17th century Europe? 1. The mentally ill were divinely inspired and should be treated with care and benevolence. 2. The body's humors were responsible; blood, bile, and phlegm must be balanced. 3. Madness was best overcome by discipline and brutality. 4. The mentally ill were possessed by evil spirits that inflicted emotional suffering.

3 Rationale 1: Seventeenth century Europe operated under the belief that madness was less than ever linked to medicine and could be overcome only by discipline and brutality. Seventeenth century society created houses of confinement where, for the entertainment of onlookers, mad persons were publicly beaten and tortured. The belief that the mentally ill were divinely inspired and thus treated with care and benevolence was held by the early Arab world. Preliterate cultures attributed mental illness to superhuman, evil spirits that inflicted pain and suffering; no distinction between medicine, magic, and religion. Hippocrates was one of the first to link mental illness with medicine suggesting an imbalance within the body's humors, but not in the 17th century. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Question 23

MCSA The new nurse is working with a preceptor on a medical-surgical unit. The nurse has just assessed a client and states to the preceptor, "This client has many odd notions regarding several common health practices. He seems like a deviant to me." In planning a response, the preceptor is guided by: 1. A definition of deviance that covers all clinical situations. 2. The knowledge that beliefs and behaviors are only deviant if the client thinks there is a problem. 3. The knowledge that beliefs and behaviors are judged by cultural and social considerations. 4. The need for further assessment to determine the duration of the beliefs and actions.

3 Rationale 1: The appropriateness of beliefs and behaviors are judged according to cultural, social, ethical, and legal rules that define the limits of appropriate behavior and reality. Given the cultural, social, ethical, and legal considerations, there is no definition of deviance that covers all clinical situations. The duration of the beliefs and actions in this situation may be irrelevant. Given the lack of a definitive definition of deviant behavior, the statement that beliefs and behaviors are only deviant if the client thinks they are a problem is an incorrect statement. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Analyze why the term "deviant behavior" lacks a definition that covers all situations. Question 11

MCSA An experienced nurse is describing the characteristics of a therapeutic one-to-one relationship to a nursing student. Which of the following is the most accurate description? 1. The relationship between the nurse and client is reciprocal. 2. The nursing process is the cornerstone of the relationship. 3. The essential feature of the relationship is a therapeutic alliance. 4. The nurse must meet the client's needs throughout the relationship.

3 Rationale 1: The essential feature of the one-to-one relationship is the creation of a therapeutic alliance between nurse and client. The nursing process is used to guide nursing care but is not a characteristic of a therapeutic nurse-client relationship. A reciprocal relationship exists in social relationships, but in professional relationships, nurses must work together with clients to address the clients' personal problems and meet their needs. The client shares the responsibility with the nurse to meet client needs throughout the relationship. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain the common shared characteristics of one-to-one relationships. Question 3

MCSA The psychiatric-mental health nurse is working with the new graduate nurse who is orienting to the psychiatric unit. Which comment by the new graduate indicates further clarification of the generalist-nursing role is needed? 1. "I would feel better if you would look at my documentation that addresses progress toward treatment goals." 2. "I will spend time each day evaluating the effectiveness of the therapeutic milieu." 3. "I am a little nervous about conducting psychotherapy with clients." 4. "I am doing some reading on how to incorporate complementary interventions into treatment plans."

3 Rationale 1: The intent to conduct psychotherapy with clients is not consistent with the role of the nurse at the generalist level of practice as outlined in the Psychiatric-Mental Health Nursing Standards of Practice and indicates a need for role clarification. Evaluation of the therapeutic milieu, documenting progress toward treatment goals, and incorporating complementary interventions are consistent with the roles of the psychiatric-mental health nurse practicing at the generalist level. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatric-mental health nursing. Question 5

MCSA If the nurse is using the nursing theory that has shaped psychiatric-mental health most directly, which nursing action is priority? 1. Assessing the client's abilities in areas of self-care 2. Teaching effective coping skills 3. Establishing a therapeutic nurse-client relationship 4. Encouraging the client's sensitivity and caring for self

3 Rationale 1: The interpersonal theory of psychiatric-mental health nursing and the therapeutic relationship originated by Peplau remains the theory that has shaped psychiatric-mental health nursing most directly. While assessing self-care abilities, encouraging sensitivity and caring for self, and teaching effective coping skills are important areas for nursing action, all efforts are supported by a therapeutic nurse-client relationship. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain why you should be capable of functioning in all theories of care. Question 30

MCSA During the shift report, a nurse describes a client as "crazy." Which approach by the nurse would be best? 1. Ask the staff what terminology they wish to use. 2. Say nothing. 3. Suggest that staff use the term "mentally ill." 4. Role model using the term "nervous breakdown."

3 Rationale 1: The nurse should suggest that staff use the term "mentally ill," thus, reinforcing that the client has an illness. The term "nervous breakdown" is too general and nonspecific for clinical usage. Saying nothing or asking staff what terminology to use is not implementing the client-advocate role of the professional nurse. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Define and explain mental disorder. Question 2

MCSA The nurse is caring for a client with depression who is withdrawn. Which of the following statements suggests that the nurse is able to challenge his or her dogmatic beliefs? 1. "I understand that clients with depression have anger turned inward." 2. "I realize that if clients would just change their negative thoughts, they wouldn't be depressed." 3. "I realize that clients with depression are not just avoiding their problems." 4. "I understand that if clients would just develop strong interests, they wouldn't be depressed."

3 Rationale 1: The nurse who realizes clients with depression are not just avoiding their problems has been challenged to change their beliefs as the result of caring for clients with depression. Continuing to hold beliefs that clients remain depressed because of negative thoughts, anger turned inward, or a lack of strong interests demonstrates that the nurse is unable or unwilling to form new ideas and research about mental illness in order to fit his or her preconceived notion of depression. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice. Question 17

MCSA The mental health team nurse is having some role issues regarding how best to facilitate client progress toward therapeutic goals. What is the priority action by the nurse in order to aid the team as they assist the client? 1. Acknowledge the diversity of the mental health team. 2. Recognize that conflict is natural and expected. 3. Determine personal values, biases, and goals. 4. Attend all mental health team meetings.

3 Rationale 1: The priority nursing action is to determine personal values, biases, and goals; these, especially if out of the awareness of the nurse, may be a factor in team dynamics. Acknowledging the diversity of the team, recognizing that conflict is natural, and attending all mental health team meetings are appropriate actions, but not the priority. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others. Question 12

MCSA The nurse is assessing a client's current progress in the nurse-client relationship. Which of the following behaviors would indicate to the nurse that the client is beginning the termination phase of the nurse-client relationship? 1. The client verbalizes willingness to change ineffective coping patterns and self-defeating behaviors. 2. The client expresses awareness of potential causes of dysfunctional behavioral patterns. 3. The client uses effective problem-solving strategies on a daily basis. 4. The client requests clarification of the roles and responsibilities in relationship work.

3 Rationale 1: The use of adaptive coping strategies on a daily basis is a useful criterion for determining readiness to terminate the therapeutic relationship. Expressing awareness of and willingness to change ineffective or dysfunctional coping behaviors indicates the client is still in the working phase of the relationship and more work needs to be done. Clarification of roles and responsibilities during relationship work may be necessary in either the orientation or working phase, but should be clearly understood by the end phase of the relationship. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 19

MCSA The nurse is planning care for the client who presents with frequent reports of multiple physical complaints. Given knowledge of the leading causes of mental disability, the nurse should plan to include further data collection in which of the following priority areas? 1. Relationships with others 2. History of family violence 3. Alcohol usage 4. Clarity of thought processes

3 Rationale 1: There is high incidence of a mental disorder in clients with physical illness. Of the five mental disorders listed among the top 10 causes of mental disability worldwide, alcohol use ranks number four. Clarity of thought processes would elicit data in regard to schizophrenia which is further down the list of leading causes. History of family violence and relationships with others are not specific to the current situation and not directly diagnostic for the other top 10 causes of mental disability. Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 16

MCSA A client states that she is unhappy and miserable in her marriage and has been for several years. Which of the following responses indicates the nurse is tuning in to the process of the client's interaction rather than the content? 1. "Do you have any children from this marriage?" 2. "How long have you been married?" 3. "It sounds like you have been miserable for quite some time." 4. "Has your husband ever cheated on you?"

3 Rationale 1: Tuning in to the process involves paying attention to verbal and non-verbal cues to identify and respond to client "themes." Acknowledging the client's misery is one way to respond to client "themes." Asking related questions about the marriage such as duration of the marriage, number of children, or possible infidelity are all examples of responding to the content of the interaction. The answers to these questions are not as important in process as encouraging the client to explore her feelings in this relationship. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 22

MCSA Which of the following statements by the nurse may prevent successful separation between client and nurse at the end of a therapeutic one-to-one relationship? 1. "I'm going to miss our sessions together, but I think you're ready to handle difficult situations on your own." 2. "I think two or three more sessions are necessary for you to develop more confidence in using this new coping skill effectively." 3. "I'm skeptical of your ability to assert yourself when new conflicts occur in future relationships, so be careful." 4. "I suggest you contact me if you experience any new crisis that you feel unprepared to deal with on your own."

3 Rationale 1: Uncertainty or doubt that the client is able to continue newly developed skills is a barrier to successful separation between nurse and client. This statement indicates the nurse has regrets that the client did not obtain sufficient skills to function independently. Suggesting additional sessions to allow for confidence to build and identifying conditions in which it would be appropriate for the client to contact the therapist are appropriate ways to wrap up the therapeutic nurse-client relationship. Acknowledging that the client is ready to tackle conflicts independently is an indication of successful separation. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Incorporate an understanding of the three phases of the therapeutic nurse-client relationship and the main objectives and therapeutic tasks of each phase into one-to-one work with clients. Question 20

A 10-year-old is brought to the clinic for assessment. During the interview, the nurse learns that the child has been the victim of domestic violence. Which of the following messages would the nurse expect to hear in the assessment of the child due to the child's experience of abuse? Standard Text: Select all that apply. 1. It is appropriate to love the people you hit. 2. Violence does not resolve conflict. 3. If you are small and weak, you deserve to be hit. 4. Violence is appropriate if the end result is good. 5. People who love you don't hit you.

3,4

A client who is being discharged from an inpatient stay has his wife bring a box of chocolates and a bouquet of flowers for his primary nurse. He presents these gifts to the nurse saying," Thank you for taking care of me." What is the most appropriate response? 1. "Thank you so much . It is so nice to be appreciated." 2. "I don't accept gifts from patients." 3. " Thank you. I will share these with the rest of the staff." 4. "Hospital policy forbids me from accepting gifts from patients."

3. " Thank you. I will share these with the rest of the staff."

A client who admits to having frequent suicidal ideations is admitted to the psychiatric inpatient unit. During the assessment interview, the client says, "I don't really need to be here, I'm very much at peace with myself now." The nurse should interpret that the client probably: 1. Has resolved suicidal feelings and is no longer a risk for self-harm. 2. Is ready to be discharged from the inpatient unit. 3. Continues to be a significant risk for suicide. 4. Can be taken off anti-depressant medication.

3. Continues to be a significant risk for suicide.

A 24-year-old client with body dysmorphic disorder (BDD) tells the nurse that he plans to have a surgical procedure that will affect his appearance. The nurse understands that this plan is an effort to: 1. Suppress intrusive thoughts. 2. Deal with multiple physical complaints. 3. Treat associated depression. 4. Cure the imagined defect.

4

A client consistently fails to accept the consequences of his or her own behavior. The nurse identifies this behavior as characteristic of: 1. Immaturity. 2. A lack of structure. 3. A need for medication. 4. A personality disorder.

4

A client who is nearing high school graduation is unable to finish out the year, cries at night, has difficulty sleeping, and does not want to attend classes. Which type of crisis does the nurse identify? 1. Trauma from previous crisis 2. Situational crisis 3. Recoil response 4. Maturational crisis

4

A client with a history of physical and sexual abuse by her husband is admitted to the hospital for treatment of vaginal lacerations. While hospitalized, the client expresses concerns to the nurse about her safety when she returns home. The first priority for the nurse is to: 1. Offer to contact outpatient services if the client promises that she will not return home after her discharge. 2. Encourage the client to take charge of her situation. 3. Make it clear to the client that her husband needs to see a therapist. 4. Assist the client to devise a safety or escape plan.

4

A client with a long history of experiencing domestic violence tells the nurse, "There is no way out for me, this situation will never change." What nursing diagnosis would be most appropriate? 1. High Risk for Violence 2. Self-Esteem Disturbance 3. Alteration in Health Maintenance 4. Powerlessness

4

A client with borderline personality disorder gives written notice of intention to leave the hospital after a voluntary admission. The client tells the nurse, "I will rescind my notice if you expand my smoking privileges." The nurse should respond in a way that: 1. Convinces the client to rescind the notice. 2. Provides exceptions to the unit rules. 3. Refers the client to the physician. 4. Consistently reinforces the unit rules.

4

An older client comes to the health center with vague complaints of abdominal discomfort. Assessment findings include several old and fresh bruises in the abdominal area, and signs of malnutrition. What is the most appropriate question for the nurse to ask? 1. "Are you dieting?" 2. "Did you have any falls lately?" 3. "Do you have an alcohol problem?" 4. "Did anyone hurt you?"

4

Domestic violence is often associated with: 1. High school dropouts. 2. The poor and undereducated. 3. Blue-collar workers. 4. All levels of society.

4

During an education session, a community member asks what causes domestic violence. The best response is: 1. The statistics indicate that it is caused by poverty. 2. It is caused by the demanding workload of either parent. 3. The police commissioner can provide complete and accurate data on the causes. 4. There is no single cause of this type of violence.

4

Identify which of the following would be detrimental for the nurse desiring to manage stress when working with a client/family in crisis. 1. Drink plenty of water and eat a balanced and healthy diet 2. Participate in memorials and rituals 3. Talk about your emotions 4. Maintain a consistent work assignment

4

The client with a diagnosis of borderline personality disorder shows the nurse multiple superficial cuts to the arms that were made during the night. The client states, "I told the night staff that I was feeling alone." The nurse recognizes that the self-mutilation may be a result of: 1. Manipulation. 2. Anxiety. 3. Splitting. 4. Impulsive behavior.

4

The nurse and a client talk about healthy ways to meet needs. The client states, "When I am looking really good, it is not asking too much for people to acknowledge me." The nurse recognizes that this experience is indicative of: 1. Affective instability. 2. Splitting. 3. Feelings of emptiness. 4. A sense of entitlement.

4

The nurse is caring for a client who has been diagnosed with dissociative disorder. The nurse knows that an appropriate intervention to promote effective role performance is to: 1. Encourage the client to have no contact with friends and family. 2. Ignore the client's other personalities. 3. Help the client alienate family members who do not believe the client is sick. 4. Include family members is therapy.

4

The nurse is conducting training for crisis counselors. The nurse would include the intervention strategies of safety and security, ventilate and validate, predict and prepare which are: 1. A way to identify when the crisis is maturational. 2. Best used before a crisis. 3. Applied when the clients are unable to progress. 4. Referred to as the ABCs of crisis counseling.

4

The nurse is preparing to assess a client with a diagnosis of paranoid personality disorder. What client characteristics will the nurse expect to observe? 1. Grandiosity 2. Superficial charm 3. Affective instability 4. Suspicions and rigidity

4

The nurse is working with a client whose brother had recently died as a result of a brain aneurism. The client reports spending the days crying or sleeping. The nurse intervenes in this situation to: 1. Encourage the client to stay busy. 2. Help the client focus on other aspects of life. 3. Provide respite from a painful reality. 4. Restore the client to pre-trauma level of functioning.

4

The nursing staff is discussing boundary setting. Which of the following statements about boundary setting is inaccurate? 1. "Boundaries are established by providing consistent expectations." 2. "Boundaries define the therapeutic relationship." 3. "Boundaries provide guidelines for self-control." 4. "Boundaries are established to make the nursing staff's job easier."

4

To intervene effectively with clients with somatoform disorders, it is essential that the nurse: 1. Help the client express a decreased degree of comfort regarding physical symptoms. 2. Encourage the client's expression of feelings symbolically through physical symptoms. 3. Address client anxiety at a later time. 4. Recognize and understand the client's self-perception as demonstrating an inability to cope.

4

What is the most therapeutic approach when caring for a client who has been the victim of domestic violence? 1. Acknowledge the client's inability to change the situation. 2. Do not ask direct questions about abuse as this will intimidate the client. 3. Invite the abuser to the assessment session. 4. Avoid pressuring the client to leave the abuser.

4

When working with sibling abuse victim, the nurse should recognize that: 1. Most adults were victims of sibling abuse. 2. 40% of all child homicides are caused by sibling abuse. 3. Parents recognize and condone physical confrontation. 4. Hitting increases the probability of violence.

4

Who is at greatest risk for becoming the victim of intrafamily violence? 1. The child who has a stepfather 2. The male child 3. The child born out of an unplanned pregnancy 4. The child living in a home in which a parent is being abused

4

MCSA During the orientation phase of the nurse-client relationship, the client presents the nurse with a framed picture that was painted during recreational therapy. What is the best response by the nurse? 1. "I'm sorry but I'm not allowed to accept any gifts from clients." 2. "How thoughtful; I'll take this home with me so I will be reminded of you every time I see it." 3. "Let's examine your motives for trying to 'bribe' me with this picture." 4. "That's a lovely picture; let's put it in the day room for everyone to enjoy."

4 Rationale 1: Acknowledging the gift and accepting it on behalf of everyone will foster the relationship and improve the client's self-esteem. Accepting the gift to take home with you may indicate you are willing to be bribed or manipulated, and the client could use this as an attempt to control the relationship. Firmly refusing this open gesture could decrease the client's self-esteem and create an uncomfortable rift in the relationship. Accusing the client of an ulterior motive by trying to "bribe" you with the gift may create hostility and distrust. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship. Question 10

MCSA When planning nursing care, the nurse understands that the main value of having knowledge of a variety of nursing theories is to be able to do which of the following? 1. Promote consideration and use of nursing research. 2. Build the skill and effectiveness of the nurse's practice. 3. Enhance collaboration and understanding between the nurse and the mental health care team. 4. Implement individualized nursing interventions depending on what is best for the client's situation.

4 Rationale 1: Approaches associated with two or more nursing theories provide the nurse with enhanced capability to implement nursing interventions and care that is individualized for clients and their situation—the whole purpose of nursing care. Building the skill and effectiveness of the nurse, enhancing collaboration, and promoting consideration and use of nursing research are nurse-centered responses and fall much lower on the priority scale than individualized, client-centered care. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Explain why you should be capable of functioning in all theories of care.

MCSA The nurse is seeking supervision regarding the use of self-disclosure with a client who has anxiety. Which response by the nurse most accurately reflects an understanding of the therapeutic use of self-disclosure? 1. "There are really few circumstances in which it is appropriate for nurses to use self-disclosure with clients." 2. "Nurses who disclose personal information must first undergo psychotherapy to prevent over-disclosure." 3. "I can use self-disclosure with any client as long as it doesn't take the focus away from the client." 4. "I will first ask myself whether what I am going to disclose meets the client's needs or just my own needs."

4 Rationale 1: Asking oneself whether the goal of the self-disclosure is to meet the client's need or the nurse's need demonstrates that the nurse realizes it is important to determine the purpose and goal for the self-disclosure before sharing personal information with the client. Although the wisdom of self-disclosure has been the subject of much debate, there are studies that support the judicious use of self-disclosure. Before using self-disclosure with a client, the nurse must consider not only if it will take the focus away from the client, but also the context of the therapeutic relationship and give attention to the timing, appropriateness, and degree. Seeking supervision when using self-disclosure is appropriate for any nurse; however, one does not need to have undergone personal psychotherapy to understand the judicious use of self-disclosure. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 12

MCSA The nurse is establishing a therapeutic alliance with a new client. Which of the following behaviors would enhance the development of a therapeutic one-to-one relationship? 1. Specifically defining emotional and social goals for the client 2. Eagerly encouraging the client to communicate on a superficial level 3. Instinctively sharing personal experiences with the client 4. Spontaneously assisting the client to identify thoughts and feelings

4 Rationale 1: Assisting the client to identify thoughts and feelings, either spontaneously or in a planned manner, will enhance the development of a therapeutic alliance. Sharing personal experiences with the client or encouraging continued communication on a superficial level are more characteristic of a social relationship than a professional relationship. The nurse should collaborate with the client to mutually define goals instead of defining goals for the client. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Explain the common shared characteristics of one-to-one relationships. Question 2

MCSA The nurse is caring for a client with depression. Which nursing intervention best demonstrates the nurse's availability to the client? 1. Let the client know that time heals all sorrow. 2. Provide privacy when interviewing the client. 3. Be honest with the client about medication effects. 4. Assist the client with the activities of daily living.

4 Rationale 1: Assisting the client with activities of daily living demonstrates that the nurse is available to the client to help with basic human needs. Providing privacy is important, but shows respect for the client, not availability. Telling the client that time heals invalidates the client's experience. Being honest with the client about medications demonstrates respect for the client, not availability. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 9

MCSA The charge nurse is reviewing the care plans for the clients on the unit. In several care plans, the nurse has noted that the words noncompliant and manipulative have been used to describe those clients with severe mental illness. The nurse plans on discussing this with the staff at the next unit meeting. Which of the following responses will demonstrate the charge nurse's personal accountability to the staff? 1. "If you use these terms regularly, you will need to reassess your reasons for working in psychiatric settings." 2. "Does the use of these terms reflect an underlying level of stress on the unit that I should be aware of?" 3. "While these terms might be accurate, they are not appropriate to use in a care plan." 4. "How might these terms reflect negativity and stigma towards persons with mental illness?"

4 Rationale 1: By asking the staff about the impact of these terms, the charge nurse is providing feedback to the staff and asking them to engage in critical thinking to improve the quality of care. Telling the staff that the terms are not appropriate to use or that by using them the staff need to reassess their reasons for working on the unit does not promote dialog or enhance problem solving. Assuming the reason for the use of the terms before engaging in a dialog with the staff closes off communication and does not enhance problem solving or feedback. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe the qualities that enable psychiatric-mental health nurses to practice the use of self artfully in therapeutic relationships. Question 13

MCSA The psychiatric nurse is asked to explain the primary focus in the assessment and treatment of mental illnesses during the mid-20th century. Given this request, the nurse would emphasize beliefs and actions related to which of the following? 1. Faulty life habits and interactions 2. Decay of intellect or of the nervous system 3. Classification of symptoms 4. Social dimension and drug treatment

4 Rationale 1: By the mid-20th century, psychiatric thinking was expanding and moving toward an emphasis on the importance of the social dimension in addition to the development of drug treatment. The belief that mental disorder was linked to faulty life habit and interactions was consistent with the late 19th and early 20th centuries. The belief that mental disorder was the product of intellect and nervous system decay and the emphasis on the classification of symptoms were more prevalent during the 18th and early 19th centuries respectively. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe how societal attitudes, philosophical viewpoints, and definitions of mental disorder have shifted throughout history. Question 24

MCSA The nurse is sharing client assessment data with the multidisciplinary health care team. Which comment by the nurse is irrelevant and indicates a misunderstanding of the concept of a mental disorder? 1. "The client reports significant emotional distress about the current situation." 2. "The client reports a loss of interest in usual pleasurable activities and commitments." 3. "The client denies thoughts of harming self or others." 4. "The client has some very inappropriate religious ideas and spiritual beliefs."

4 Rationale 1: Deviant religious beliefs and behavior are not generally labeled as mental disorders unless the deviance is a symptom of dysfunction. Thoughts of harming self or others, emotional distress, and a loss of interest in usual pleasurable activities and commitments are relevant and meet the generally accepted definition of a mental disorder. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Define and explain mental disorder. Question 4

MCSA The nurse notices that a client is unable to control anger when criticized during a group meeting, even though the client had been able to do this effectively for several weeks. Which of the following interventions would be most appropriate in the nurse's next one-to-one therapeutic session with the client? 1. Encourage the client to express responses to criticism freely. 2. Insist the client take a "time-out" until anger is back under control. 3. Offer the client a PRN dose of ziprasidone (Geodon®). 4. Encourage a detailed exploration of how the client reacts to criticism.

4 Rationale 1: Encouraging an in-depth exploration of the client's feelings and thoughts can contribute to increased insight. Moving too quickly and incompletely through an exploration of feelings may explain the client's inability to maintain new behaviors. Encouraging the client to express responses to criticism freely is inappropriate because of the risk of harm to self or others. Insisting the client take a time-out, or offering the client a PRN medication for agitation, may be appropriate for immediate action, but would not be necessary during the next one-to-one therapeutic session. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 26

MCSA A client who is being discharged offers the nurse a ceramic bowl made during hospitalization as a symbol of the open "vessel" the client has become for accepting new ideas. What is the best response by the nurse? 1. "This is a beautiful gesture, I will place it in the day room for everyone to enjoy." 2. "I wish I could accept this, but you know I'm not allowed to." 3. "Let me pay you for this. I don't feel I should just accept it after all the hard work you put into it." 4. "You worked very hard on becoming receptive to new ideas this past month; I would be honored to accept this symbol of your progress."

4 Rationale 1: Gifts are most often given during the termination phase of one-to-one relationships. It is appropriate to accept a gift if feelings and the motive for giving the gift have been clarified. Placing a breakable object in the day room of an inpatient unit is inappropriate due to safety risks. Refusing to accept the gift is a personal choice the nurse could make; however, the client may feel disappointed and rejected by this refusal. Paying the client for any item is discouraged and usually against hospital policy. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Analyze how phenomena such as resistance, transference, countertransference, critical distance, gift giving, the use of touch, and the values held by both client and nurse affect the therapeutic relationship. Question 11

MCSA The nurse is admitting a client who is from Kenya to the psychiatric unit. Which of the following actions will demonstrate cultural competence? 1. Arrange for an interpreter to assist. 2. Ask a family member to stay during the assessment interview. 3. Follow the admission assessment form. 4. Talk with the client to determine fluency in English.

4 Rationale 1: In planning culturally competent care, the nurse must not make assumptions regarding a client's language preference and/or cultural needs. The nurse does not follow a predetermined plan for assessing clients, but instead takes the time to determine client needs based on the client's responses. Arranging for an interpreter or asking a family member to stay makes a predetermined assumption about the client's cultural needs or issues before a thorough assessment is done. While following an admission assessment form may assist the nurse in the process of admitting the client, assessing the client's cultural preferences requires time and creativity to which a predetermined assessment form may not lend itself. Global Rationale: Cognitive Level: Applying Client Need: Physiological Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice. Question 19

MCSA The nurse educator is reviewing a student's care plan. Which of the following nursing diagnoses would not be appropriate to include when a patient experiences regressive behavior during the termination phase of the nurse-client relationship? 1. Ineffective Coping 2. Self-care Deficit 3. Powerlessness 4. Knowledge Deficit

4 Rationale 1: Knowledge deficits regarding appropriate community resources, self-medication, or other independent responsibilities are common issues during the termination phase. Clients who are ambivalent regarding the termination of a therapeutic relationship may exhibit regressive behaviors and revert to previous self-defeating behaviors in an attempt to prolong treatment and avoid separation. Examples of regressive behaviors may indicate powerlessness, hopelessness, self-care deficits, and ineffective coping. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: Apply the nursing process to the three phases of the nurse-client relationship. Question 27

MCSA The nurse is asked to provide traits of a mentally healthy individual at a hospital in-service. The nurse knows that mentally healthy individuals are: 1. Physically healthy and dependent. 2. Middle-aged and physically ill. 3. Dependent and needy. 4. Independent and autonomous.

4 Rationale 1: Mentally healthy people are independent and autonomous. They think well of themselves and others, but are also realistic about their own and others' abilities and shortcomings. They can accept the ups and downs of life and often come out even stronger than before. They have a wide range of behaviors, emotions, and values that are usually consistent with one another. The other choices do not necessarily describe someone who is mentally healthy. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Compare and contrast the essential characteristics of mental health with mental disorder. Question 13

MCSA The nurse is interviewing a Native American client who acknowledges seeing "spirits." Which of the following actions will be most important for the nurse to take to assist in assessing this client's symptoms? 1. Carefully question the client's family to prevent aggravating this symptom. 2. Observe the client's behavior to determine how the client expresses this symptom. 3. Consult the physician regarding how best to evaluate this symptom. 4. Obtain a profile of the client's cultural norms on which to interpret this symptom.

4 Rationale 1: Nurses who are culturally competent assess symptoms in light of clients' cultural norms by obtaining a cultural profile. Consulting the physician will not assist in assessing and interpreting this symptom based on the client's cultural norms. Questioning the client's family may provide additional assessment data for a cultural profile but does not impact the degree to which the client experiences the symptoms. Observing a client's behavior will provide assessment data, but not cultural data on which to interpret the symptoms. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Foster culturally competent care for clients with psychiatric mental health disorders by understanding the influence of your own sociocultural background on your nursing practice. Question 21

MCSA The nurse is working with a client who becomes upset and tells the nurse, "I've decided to give up on finishing my bachelor's degree." Which response best reflects the nurse's belief that the client is able to find the solution to this concern? 1. "You don't need to make a decision about this right now." 2. "It is probably too much for you to handle right now." 3. "If you put your mind to it, you could finish the program." 4. "It sounds like you feel it is too much for you to finish now."

4 Rationale 1: Reflecting back to the client what the nurse has heard is a therapeutic technique that facilitates the client's ability to problem-solve. Telling the client that it is probably too much or that the client does not need to make a decision assumes that the nurse knows what the client needs without taking time to explore the client's feelings. Telling the client that success depends on putting one's mind to it suggests that the client is to blame for the decision to give up. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Provide examples of how the concepts of blame and control affect artful therapeutic practice. Question 16

MCSA The client has frequently presented to the clinic with multiple physical complaints. The multiple physical complaints would warrant the nurse to screen the client for: 1. A chronic illness. 2. Deviant behavior. 3. Hospitalization. 4. A mental disorder.

4 Rationale 1: Researchers have found high incidences of mental disorder in clients seen for physical illnesses; thus, risk is increased. The risk for chronic illness, hospitalization, and deviant behavior is not necessarily increased given the information in the question. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 14

MCSA During a staff meeting, a nurse makes the following remark about the clients on the unit, "These clients are just trying to avoid the problems of life. They just need to go out and work." Which of the following responses best demonstrates the charge nurse's respectful attitude toward this nurse? 1. "I agree that most clients are just avoiding life, but our mission is to provide care." 2. "It is not our responsibility to determine whether clients have problems or not." 3. "You seem to be having trouble accepting the fact that clients can lose emotional control of their lives. Why don't we talk about this as a group?" 4. "When you say that our clients are just avoiding life problems, it sounds like you are frustrated by the needs our clients express. Am I hearing you correctly?"

4 Rationale 1: Restating what the nurse has said and asking if that is a correct understanding allows the charge nurse to maintain a respectful attitude by taking the time and energy to listen to and understand the colleague's experience. Suggesting that the nurse has trouble with clients who lose control and asking to talk about it as a group makes an assumption and threatens the nurse's self-esteem. Stating that it is not a responsibility of the staff to determine whether clients have problems fails to address the nurse's concerns. Agreeing with the nurse's opinion does not demonstrate honesty or integrity when addressing difficult issues with colleagues. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues. Question 28

MCSA The nurse educator is teaching a group of students about psychiatric-mental health nursing concepts. Which intervention best demonstrates practicing with the concept known as detached concern? 1. Sharing personal beliefs and opinions in order to enhance connection with the client 2. Providing a critical perspective of the client's feelings 3. Setting rigid boundaries to separate the nurse's experience from the client's 4. Sitting quietly with a client who is sobbing uncontrollably

4 Rationale 1: Sitting with a client who is experiencing a difficult emotion means the nurse is comfortable with people who may not be able to control their feelings and can separate the client's experiences and feelings from the nurse's self-view. Sharing personal beliefs with clients indicates the nurse cannot separate the nurse's identity from the client's identity. Setting rigid boundaries indicates the nurse's identity is threatened by the client's behaviors. Providing a critical perspective of a client's feelings invalidates the client's experience and interferes with a therapeutic relationship. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Discuss the concept of personal integration and how it relates to psychiatric-mental health nursing practice. Question 5

MCSA Upon the client's arrival on the patient care unit, the nurse begins implementation of the nursing process. Of which nursing theorist should the nurse's practice be most reflective? 1. Ida Jean Orlando 2. Jean Watson 3. Dorothea Orem 4. Hildegard Peplau

4 Rationale 1: Some say that the phases of Peplau's therapeutic nurse-client relationship are ancestors of the phases of the nursing process. While Orem, Watson, and Orlando guide the nurse in areas for assessment, analysis, planning, intervention, evaluation, etc., they do not identify specific phases or steps of the nurse-client interaction process. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Discuss the nursing theory concepts and principles that have shaped psychiatric-mental health nursing most directly. Question 28

MCSA The nurse educator is teaching a group of students about stigma. The educator states that stigma can affect the judgment of which of the following people about the person who is labeled as mentally ill? 1. God or other higher powers 2. Family 3. Health care providers 4. Co-workers 5. Friends

4 Rationale 1: Stigma is an attitude that leads to prejudice and discrimination. It affects the judgments of family, friends, coworkers, health care providers, and others about the person labeled mentally ill. There is no evidence that stigma will affect the relationship that the mentally ill person has with God or other higher powers. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Explore the meaning of stigma for clients, families, friends, communities, and mental health caregivers and agencies.

MCSA The psychiatric-mental health nurse reflecting on professional role activities is referred to the standards of professional performance by a colleague. To which organization should the nurse look for guidance? 1. North American Nursing Diagnosis Association 2. American Nurses Credentialing Center 3. National League for Nursing 4. American Nurses Association

4 Rationale 1: The American Nurses Association will be the best resource as professional performance is addressed in standards 7-15 of ANA's Psychiatric-Mental Health Nursing Standards of Practice. The National League for Nursing primarily addresses nursing education, while the American Nurses Association Credentialing Center focuses on certification. The North American Nursing Diagnosis Association develops a classification system for nursing diagnoses. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatric-mental health nursing. Question 4

MCSA The nurse is told that the client most likely has the diagnosis of obsessive-compulsive disorder. The nurse is not sure of the assessment data and behaviors that accompany this disorder. Which action would be most appropriate for the nurse to take? 1. Document all subjective and objective data provided by the client. 2. Ask the primary health provider to identify needed subjective and objective assessment data. 3. Research obsessive-compulsive disorder in the medical dictionary. 4. Consult the Diagnostic and Statistical Manual of Mental Disorders for diagnostic criteria.

4 Rationale 1: The Diagnostic and Statistical Manual of Mental Disorders provides diagnostic criteria that all members of the health care team will use in the diagnosis process and will serve as a resource for assessment and analysis of data. While communication with the primary care provider is appropriate, knowledge of the DSM is expected in a graduate nurse and this choice does not reflect an application of basic knowledge. A medical dictionary is not specific enough for diagnostic purposes. Documentation of all subjective and objective data is not appropriate and will confuse relevant from irrelevant data. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Define and explain mental disorder. Question 8

MCSA The nursing student is asked which historical event was most significant in the development of psychiatric nursing as a specialty and psychotherapeutic roles for nurses. Which response by the nursing student indicates understanding of important events related to development of the psychiatric nursing role? 1. Release of the report Nursing for the Future 2. Passage of the Community Mental Health Centers Act 3. Publication of Commonsense Psychiatry 4. Passage of the National Mental Health Act

4 Rationale 1: The National Mental Health Act of 1946 is probably the most significant piece of legislation affecting the development of psychiatric-mental health nursing. Within this act, psychiatric nursing was added to psychiatry, psychology, and social work as a field in which the highest priority became the preparation of clinically capable persons for positions of leadership. Commonsense Psychiatry, written by Adolf Meyer, had great impact on psychiatry; however, it did not have a noticeable influence on psychiatric nursing. Nursing for the Future eliminated single-focus schools of psychiatric nursing. The Community Mental Health Centers Act of 1963 encouraged the closing of large mental hospitals and further encouraged the trend toward expanded nursing roles at the graduate level. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 21

MCSA The nurse is serving on a committee charged with reviewing the roles and responsibilities of the nurses on the psychiatric unit. Which publication should the nurse bring to the first meeting? 1. Diagnostic and Statistical Manual of Mental Disorders 2. American Nurses Credentialing Center certification requirements 3. American Nurses Association, Code of Ethics 4. Psychiatric-Mental Health Nursing Standards of Practice

4 Rationale 1: The Psychiatric-Mental Health Nursing Standards of Practice delineates psychiatric-mental health nursing roles and functions and serves as guidelines for providing quality care. The Diagnostic and Statistical Manual of Mental Disorders is used by the mental health care team, particularly the psychiatrist, to diagnose clients with mental disorders and is not specific to nursing care issues. The Code of Ethics helps to clarify right and wrong actions by the nurse, but does not clarify roles and nursing care actions. Certification requirements outline steps toward certification that acknowledge knowledge and expertise, but do not delineate roles and responsibilities. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Apply knowledge of current practice and professional performance standards to the delivery of contemporary psychiatric-mental health nursing. Question 3

MCSA A nursing student asks the nurse educator the differences between social and professional relationships. The nurse educator knows that the defining characteristic of a professional relationship is which of the following? 1. Can be either spontaneous or planned 2. Is the only relationship where roles are defined 3. Requires more planning, consistency, and time 4. Does not address the personal needs of the nurse

4 Rationale 1: The defining characteristic of a professional relationship is that it is not intended to address the personal needs of the nurse. A formal one-to-one relationship requires more planning, consistency and time than an informal therapeutic relationship, but this is not a feature distinguishing professional relationships from social relationships. Professional relationships can be spontaneous or planned; however, this is not unique to professional relationships, particularly in organizational or educational settings. Roles in social relationships may be governed by broad social norms such as the roles of lover or friend. Global Rationale: Cognitive Level: Analyzing Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Explain the common shared characteristics of one-to-one relationships. Question 4

MCSA Observation of the behavior of the mental health team seems to indicate that one team member is primarily interested in client progress as a measure of their knowledge and expertise. Given the nurse's knowledge of game theories, this team member might be functioning as which of the following? 1. Rivalist 2. Leader 3. Enabler 4. Maximizer

4 Rationale 1: The maximizer is one who is primarily interested only in his or her own gain. A rivalist would be a person whose primary interest is "defeating" other team members. An enabler is one who facilitates the continuation of what are usually inappropriate behaviors in others and usually not associated with game theory. A leader would function more in the role of a cooperator, one who is interested in helping both themselves and their partners. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others. Question 14

MCSA Upon arrival on the psychiatric unit this morning, which activity should be the nurse's focus? The nurse should do which of the following? 1. Review psychological testing results for all clients. 2. Schedule the individual therapy sessions for all clients. 3. Identify community resources for clients to be discharged this morning. 4. Assess each client for whom the nurse will be providing care.

4 Rationale 1: The nurse is responsible for implementing the nursing process and nursing care for clients. The psychiatric social worker has major responsibility for the identification of post-discharge community resources. The clinical psychologist's primary foci are psychotherapy and psychological testing. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatric-mental health nurse and other members of the mental health team. Question 9

MCSA The client's treatment plan includes teaching related to possible side effects of psychotropic medications. Which member of the mental health team should plan to implement the teaching? 1. The psychosocial rehabilitation worker 2. The primary therapist 3. The psychiatrist 4. The nurse

4 Rationale 1: The nurse is responsible for the nursing care of the client including medication administration and teaching. While the psychiatrist may also do some teaching, he/she is primarily responsible for the diagnosis and medication prescription. The primary therapist is most likely a clinical psychologist or psychiatric social worker who would not have the educational preparation or license consistent with medication teaching. The psychosocial rehabilitation worker is an unlicensed member of the team and would not have the role of medication teaching. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Compare and contrast the differences and similarities among the roles of the psychiatric-mental health nurse and other members of the mental health team. Question 11

MCSA A family member caring for a relative with dementia complains of exhaustion. Which of the following responses best conveys respect for this family member's situation? 1. "It sounds like your home situation is too demanding. What about seeking individual therapy to cope with your issues?" 2. "I experienced the same thing with my mother. What about getting a housekeeper?" 3. "Caring for a person with dementia is too much for one person. You should place your relative in a nursing home." 4. "It sounds like you are overwhelmed. You may benefit from respite care services."

4 Rationale 1: The nurse shows respect for the client and situation by validating feelings and suggesting an option that will support the client's needs. Self-disclosure of the nurse's experience and suggesting a housekeeper takes the focus away from the client's experience. Although acknowledging that caring for a person with dementia is too much for one person can validate the client's experience, suggesting a nursing home conveys the nurse's personal opinion rather than offering an option that will support the client's needs. Commenting that the home situation is demanding and suggesting therapy makes an inaccurate assumption of the client's experience and needs and again offers the nurse's personal opinion. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Maintain a respectful attitude toward clients, their families, and colleagues. Question 27

MCSA The nurse is planning care for a client who has been withdrawn and isolated for the last three days. Which action will best demonstrate the nurse's empathy for this client? 1. Encourage the client's attendance and participation in groups. 2. Focus on the client's strengths to enhance self-esteem. 3. Explore the client's feelings of anger related to powerlessness. 4. Approach the client regularly and spend time with the client.

4 Rationale 1: The nurse who acknowledges and focuses on being with a withdrawn client demonstrates a willingness to understand the experience of the client on his or her terms. Focusing on the client's strengths conveys respect and hope. Exploring feelings related to powerlessness makes the assumption that the nurse already knows the client's inner experience. Encouraging attendance and participation in groups does not respond to the client's feelings or experience. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Demonstrate empathy in psychiatric-mental health clinical practice. Question 25

MCSA The nurse reflecting on the nursing role within the mental health team, understands that the main purpose of delivering care using a multidisciplinary team is to do which of the following? 1. Maximize the efficiency of the health care team with each team member learning from the others. 2. Increase the opportunity for interpersonal interaction among the client, family, and team members. 3. Facilitate the case management process by delivering care using a multidisciplinary health care team. 4. Make the best use of the different abilities of mental health team members in order to facilitate client progress.

4 Rationale 1: The purpose of partnering and collaborating with other disciplines is to make the best use of the different abilities of mental health team members in order to facilitate client progress toward therapeutic goals. While client-centered interpersonal interaction within a therapeutic relationship is a vital piece of the treatment plan, interpersonal interaction unto itself may not be the needed focus. Facilitating the case management process and maximizing efficiency of the health care team are not primary purposes of a team approach. All care must be focused on the clients and their needs. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: Analyze the factors that influence the success with which the mental health team achieves collaboration among its members and with clients and their significant others. Question 13

MCSA The nurse is assessing a client in the home. Given the nurse's knowledge of the top 10 causes of disability worldwide, choose the priority area for data collection. 1. Social interactions and history of abuse 2. Irrational fears and quality of communication 3. Memory and childhood history 4. Mood and patterns of alcohol usage

4 Rationale 1: Unipolar depression, bipolar disorder (both mood disorders), and alcohol use all rank among the top 10 causes of disability worldwide and therefore, are priorities for assessment. Irrational fears, quality of communication, social interactions, history of abuse, memory, and childhood history may be assessed at some point; however, these areas are generally not specific to the mental disorders ranked among the top 10 causes of disability. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: Name the five mental disorders that rank among the top ten causes of disability worldwide. Question 20

MCMA The nurse is writing a scholarly paper on early nursing leaders who made major contributions to the development of the multifaceted psychiatric nursing role of today. The nurse should include which of the following nurses when writing the paper? Standard Text: Select all that apply. 1. Florence Nightingale 2. Frances Sleeper 3. Linda Richards 4. Gwen Tudor (Will) 5. Hildegard Peplau

4,5 Rationale 1: Florence Nightingale. Noted that the influence of nurses went beyond physical care; however, she emphasized physical care and made no other significant contributions to the role of the psychiatric nurse. Rationale 2: Frances Sleeper. Advocated the use of psychiatric nurses as psychotherapists. Rationale 3: Linda Richards. Worked toward better nursing care in psychiatric hospitals; however, had minimal impact on the current role of psychiatric nurses. Nurses of her era focused on more custodial physical nursing care. Rationale 4: Gwen Tudor (Will). Designed a nursing intervention that demonstrated that nurses can promote emotional growth in clients and that the psychotherapeutic nursing role can be taught to others. Rationale 5: Hildegard Peplau. Published Interpersonal Relations in Nursing, the first systematic theoretic framework in psychiatric nursing, a milestone in the development of the psychiatric nursing roles and practice. Global Rationale: Cognitive Level: Applying Client Need: Psychosocial Integrity Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: Describe how the role of the psychiatric-mental health nurse changed over the years from that of custodian to a multifaceted role. Question 22

The student nurse realizes that individuals who self-mutilate may: 1. Process feelings verbally if someone listens. 2. Never learn how to control their urges. 3. Cut for attention only. 4. Have experienced childhood abuse and have difficulty processing feelings.

4. Have experienced childhood abuse and have difficulty processing feelings.

Age range of the Generativity vs. Stagnation stage of Erikson's theory

40's & 50's (middle age) (Making your mark on the world/being part of a bigger picture/leads to the virtue of care)

Age range of the Industry vs. Inferiority stage of Erikson's theory

5 to 13 (school-age)

Age range of the Integrity vs. Despair stage of Erikson's theory

60's and older (older adult)

A fifteen-year-old client was depressed due to loss of the client's mother and placed on venlaxafine (Effexor). Two weeks later, the client tells the nurse at the clinic that he feels "worse and have no hope." What nursing action is a priority?

: Assess for suicidality.

What part of the brain is responsible for coordinating the activity of the pituitary

= hypothalamus "HYPO Thermostat"

What part of the brain is responsible for coordinating the autonomic nervous system

= hypothalamus "HYPO Thermostat"

What part of the brain is responsible for coordinating the controlling body temperature

= hypothalamus "HYPO Thermostat"

What part of the brain is responsible for coordinating the involved in sleep and emotional activity

= hypothalamus "HYPO Thermostat"

What part of the brain is responsible for coordinating the thirst and hunger, and other homeostatic systems

= hypothalamus "HYPO Thermostat"

The client asks the nurse how SSRI antidepressant that is prescribed works. What nursing response is

? Correct C. SSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain.

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is

? Correct Often people of Asian extraction have lower metabolic rates and need lower amounts of medication.

During a recent counseling session with a depressed client, the psychiatric nurse observes signs of transference. Which statement by the client indicates the nurse is

? Correct b. "You sure do remind me of my mom."

1. When assessing whether a client is exhibiting adaptive responses to stressors, the nurse must recognize which of the following? a. Adaptive responses are those that preserve the integrity of the individual. b. Adaptive responses eliminate all stressors. c. Adaptive responses can only be achieved through intensive therapy. d. Adaptive responses are whatever the client perceives them to be.

A

according to Maslow's hierarchy of needs, Which client action would be considered most basic?

A client discusses the need for avoiding harm and maintaining comfort

The nurse understands that underlying issue of most intimate partner violence is:

A desire to overpower & control

How long do antidepressants take to work?

A lot of psych medications take weeks to work, especially antidepressants

The major difference between bipolar disorder and major depressive disorder is that in bipolar disorder there is:

A mania component

The nurse and a client talk about healthy ways to meet needs. The client states, "When I am looking really good, it is not too much for people to acknowledge me." The nurse recognizes that this experience is indicative of:

A sense of entitlement

A patient tells the nurse, "my daughter has me ruled incompetent. I'm going to ask the doctor to reverse that ruling." The nurses reply should be predicted on the fact that:

A separate court hearing is required to reverse the ruling

A patient tells the nurse, "My daughter had me ruled incompetent. I'm going to ask the doctor to reverse that ruling." The nurse's reply should be predicated on the fact that:

A separate court hearing is required to reverse the ruling.

Nurse G is assessing a pt. who gives the impression of being anxious. Nurse G seeks to validate this impression because anxiety is:

A subjective experience of the individual

Which of the following treatment regimens would most appropriately be ordered for a client with PTSD? A. Paroxetine and group therapy. B. Alprazolam and behavior therapy. C. Diazepam and desentization therapy D. Carbamazepine and cognitive behavioral therapy.

A. Paroxetine and group therapy.

A client who is a veteran of the war in Iraq, is diagnosed with PTST. He sasys to the nurse, "I can't figure out why God took by buddy instead of me." From the statement the nurse asseses which of the following in the client? A. Surivor's guilt B. Intrusive thoughts C. Repressed anger D. Spirtual distress

A. Surivor's guilt

Which of the following is true regarding the diagnosis of adjustment disorder? A. The symptoms will likely remit once the client has accepted the changes that precipitated the difficulties with the adjustment B. The client will benefit from long-term psychotherapy to achieve relief. C. Adjustment disorders are not typically related to an identified stressor. D. The client inherited a genetic tendency for the disorder.

A. The symptoms will likely remit once the client has accepted the changes that precipitated the difficulties with the adjustment

"A generalist who works in a specialized setting, this nurse provides the bulk of the nursing care to clients. Registered nurses offer direct and indirect care through the nurse-client relationship. They have major responsibility for the milieu and have contact with clients at all stages of daily life." describes which of the following? A. basic level psychiatric-mental health nurse (PMH) B. advanced practice registered nurse (APRN)

A. basic level psychiatric-mental health nurse (PMH) (There are two levels of professional practice in psychiatric- mental health nursing. The basic level psychiatric-mental health nurse (PMH) may have received basic nursing preparation in a diploma, associate degree, or baccalaureate program. Essentially a generalist who works in a specialized setting, this nurse provides the bulk of the nursing care to clients. Registered nurses offer direct and indirect care through the nurse-client relationship. They have major responsibility for the milieu and have contact with clients at all stages of daily life. Nurses at this level may seek certification as generalists through the ANA's American Nurses Credentialing Center (ANCC))

What are the four Neurotransmitters you need to know about

ACh, DA, histamine, NE, serotonin

2. An eight-year-old child with the diagnosis of oppositional defiant disorder is more likely to have which of the following condition

ADHD

What is the FIRST intervention for a patient experiencing Hallucinations?

ALWAYS SAFETY FIRST

The staff observe that a young male manifests oppositional defiant behavior when he interacts with male staff. He recently was placed in his father's custody since his mother was deployed in the military. He tells the nurse that his father is always on his case, yells at him & tells him he cannot do anything right. Based on his family history, the nurse understands the client may be:

Acting out a life script (He yells at staff bc dad yells at home)

What is the difference between acute stress disorder and adjustment disorder?

Acute stress comes on after a trauma whereas adjustment disorder is related to life changing, but mostly normal, events (having a baby/diagnosis of an illness)

*On test: What is difference between Mood and Affect?

Affect is the visible reaction a person displays toward events (can be observed by nurse), while Mood is the underlying feeling state.

Does the following describe a cognitive or affective assessment: Values and beliefs involving questions about attitudes, interests, and values?

Affective

Benzodiazepines are used in the treatment of: Alcohol withdrawal and anxiety disorders. Hallucinations and delusions. Bipolar disorder. Depressive disorders.

Alcohol withdrawal and anxiety disorders

Benzodiazepines are used in the treatment of:

Alcohol withdrawal and anxiety disorders.

Patients taking Nardil (Phenelzine) or Parnate(Tranylcypromine) should avoid what types of foods?

Alcohol, aged cheese, and processed meats which contain tyramine

3. nurse is working for family that just survived a tornado, what reaction is not normal

All family members will process experience in the same pace

The nurse is helping the client with body dysmorphic disorder. The nurse can expect that the client may have which of the following?

All of the above

An individual may be considered gravely disabled for which of the following reasons;

All of the above.

brief verbal response, related to diminished thoughts describes which symptom of schizophrenia?

Alogia

The limbic system consists of which of the following structures:

Amygdala, hippocampus, diencephalon

The limbic system consists of which of the following structures?

Amygdala, hippocampus, diencephalon.

The limbic system consists of which of the following structures? Amygdala, hippocampus, diencephalon. Pons, medulla oblongata, midbrain. Thalamus, hypothalamus, occipital lobe. Pituitary, adrenal cortex, frontal lobe.

Amygdala, hippocampus, diencephalon.

*inability to experience pleasure describes which symptom of schizophrenia?

Anhedonia

A client talks in a monotone voice and shows no emotion when speaking. The client tells the nurse "I want to stay in bed all day. I do not enjoy watching television like I used to. I do not want to talk with other people." which of the following symptoms of schizophrenia or illustrated in the scenario? select all that apply

Anhedonia Flat affect Avolition Apathy

A client talks in a monotone voice and shows no emotion when speaking. The client tells the nurse "I want to stay in bed all day. I do not enjoy watching television like I used to. I do not want to talk with other people." Which of the following symptoms of schizophrenia are illustrated in this scenario? Select all that apply. Alogia. Anhedonia. Flat affect. Avolition. Apathy.

Anhedonia, Flat Affect, Avolition, Apathy

A client talks in a monotone voice and shows no emotion when speaking. The client tells the nurse "I want to stay in bed all day. I do not enjoy watching television like I used to. I do not want to talk with other people." Which of the following symptoms of schizophrenia are illustrated in this scenario? Select all that apply.

Anhedonia. Flat affect. Avolition Apathy.

A client talks in a monotone voice and shows no emotion when speaking. The client tells the nurse "I want to stay in bed all day. I do not enjoy watching television like I used to. I do not want to talk with other people." Which of the following symptoms of schizophrenia are illustrated in this scenario? Select all that apply.

Anhedonia. Flat affect. Avolition. Apathy.

*A severe schizophrenic person is unaware of why they would be in the psych hospital is an example of which symptom of schizophrenia?

Anosognosia

*someone is unaware of own severe mental condition describes which symptom of schizophrenia?

Anosognosia

Classes of antidepressant medication include all except the following: Tricyclics. Selective serotonin reuptake inhibitors. Monamine oxidase inhibitors. Anticholinergics.

Anticholinergics

During a staff medications management class, the nurse discusses the use of antipsychotic medications to treat psychosis. Which of the following statements indicate how these medications affect neurotransmitter activity? Antipsychotics decrease the sensitivity of the receptor sites on the post-synaptic neuron. Antipsychotics increase dopamine receptors. Antipsychotics increase the amount of dopamine in the post-synaptic neuron. Antipsychotics block dopamine receptors.

Antipsychotics block dopamine receptors

During a staff medications management class, the nurse discusses the use of antipsychotic medications to treat psychosis. Which of the following statements indicate how these medications affect neurotransmitter activity?

Antipsychotics block dopamine receptors.

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to

Anxiety

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to Anxiety Alcohol dependency Mania Depression

Anxiety

What are the 5 As of Schizophrenia?

Apathy/flat affect Alogia Avolition Anhedonia Anosognosia

Which of the following questions would the nurse ask a woman to assess for hyperprolactinemia as a side effect of an antipsychotic medication?

Are you having any discharge from your breasts?

Which of the following questions would the nurse ask a woman to assess for hyperprolactinemia as a side effect of an antipsychotic medication? Are you having trouble sitting still? Are you having any discharge from your breasts? Do you have a dry mouth? Are you constipated?

Are you having any discharge from your breasts?

A young client frequently engages in high risk behaviors, including driving at high speeds, drinking in excess, and engaging in high risk sexual behaviors. it is more important for the nurse assessing the client to recognize that there is high probability that:

Arrested maturation is impairing judgement.

A 15 y/o client was depressed due to loss of mother & placed on Effexor, 2 wks later the pt. tells the nurse he feels worse & has no help. What nursing action is a priory?

Assess for suicidality

A fifteen-year-old client was depressed due to loss of the client's mother and placed on venlafaxine (Effexor). Two weeks later, the client tells the nurse at the clinic that he feels "worse and have no hope." What nursing action is a priority

Assess for suicidality

A fifteen-year-old client was depressed due to loss of the client's mother and placed on venlaxafine (Effexor). Two weeks later, the client tells the nurse at the clinic that he feels "worse and have no hope." What nursing action is a priority? Assess for suicidality. Assess if the client is sleeping at night. Ask what the client enjoys. Evaluate how the client's other family members cope.

Assess for suicidality

A fifteen-year-old client was depressed due to loss of the client's mother and placed on venlaxafine (Effexor). Two weeks later, the client tells the nurse at the clinic that he feels "worse and have no hope." What nursing action is a priority?

Assess for suicidality.

4. A pt. is brought to ED after house fire, after pt. is stabilized, what is first phase of crisis intervention

Assess the impact of this experience on the pt.

The client's medication sheet contains an order for sertraline hydrochloride (Zoloft). To ensure safe administration of the medication, the nurse would administer the dose:

At the same time each day after breakfast

The client's medication sheet contains an order for sertraline hydrochloride (Zoloft). To ensure safe administration of the medication, the nurse would administer the dose: On an empty stomach. At the same time each day after breakfast Evenly spaced around the clock. As needed when the client complains of depression.

At the same time each day after breakfast

What is the goal of Erikson's Trust vs. Mistrust stage

Attachment (Sets the stage for life-long expectations. Achieved trust ensures view that the world will be a good and pleasant place)

*Your patient is having hallucinations, hearing voices, delusions, and has very concrete thinking (literal thoughts). What medication should you prescribe?

Atypical or 2nd generation antipsychotic meds are first line of treatment for schizophrenia *Atypical or 2nd generation antipsychotic meds are first line of treatment for __________. = schizophrenia

4. Marked deficits and developmentally inappropriate social relatedness across multiple contexts; including repetitive motor movements or restricted, fixated interests, is characteristic of:

Autism Spectrum Disorder (ASD)

Once identified, what can you do as the nurse to combat countertransference?

Avoid self-disclosure and give a goal-directed response. (Once the countertransference process is identified, you can consciously develop therapeutic, goal-directed responses. Avoid self-disclosure of countertransference to clients While transference involves the client's reactions to the psychiatric nurse, countertransference involves the nurse's reactions to the client.)

*inability to pursue goal directed activities describes which symptom of schizophrenia?

Avolition

A 22 year old male patient is diagnosed with schizophrenia,. The nurse notes that he is often forgetful and seems disinterested in activities. Furthermore, he has difficulty completing tasks. The nursing planning of care will address strategies based on the understanding that these behaviors are due to :

B. Problems in cognitive functioning.

Unconscious fantasies, feelings and attitudes the nurse holds toward the client: A. Resistance B. Countertransference C. Acting out D. Transference

B. Countertransference

The contributions of Florence Nightingale that remain a part of contemporary nursing practice is the idea that : A. Psychiatric nurses should have advanced preparation B. Nurses should consider psychological and social components of care as well as the physical C. Psychotic behavior must be controlled before psychotherapy begins D. Basic physical needs must be addressed before emotional

B. Nurses should consider psychological and social components of care as well as the physical

Which behavior would be most characteristic of an individual with narcissistic personality disorder?

Belief that he is entitled to special privileges that other may not have

Which behavior would be most characteristic of an individual with narcissistic personality disorder?

Belief that he is entitled to special privileges that others may not have.

What two medications are given in combination to treat EPS?

Benztropine is given with Haldol to treat EPS

Of all the psychiatric disorders, which has the highest suicide rate?

Bipolar

______ and ADHD commonly occur together in children.

Bipolar

client doesn't respond or stop mid-sentence describes what positive symptom related to excessive speech pattern in schizophrenia?

Blocking

What neurotransmitter is acted on in the first versus the second generation antipsychotics?

Both affect dopamine, but second generation also affects serotonin (know for test) which helps control EPS symptoms Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to anxiety

What two SNRIs can cause serotonin syndrome?

Bupropion (Wellbutrin) and Effexor (venlafaxine)

Which of the following may be influential in the predisposition to PTSD? A. Unsatisfactory parent/child relationship. B. Excess of the neurotransmitter serotonin. C. Severity of the stressor and availability of support system. D. Overly negative cognitive distortions about the world.

C. Severity of the stressor and availability of support system.

The client uses a destructive form of resistance to externalize an inner conflict: A. Resistance B. Countertransference C. Acting out D. Transference

C. Acting out

*SSRIs can be fatal when taken with ______ or _______.

CAN BE FATAL IF TAKEN FOR MAOI or ST JOHNS WART

What are the Treatments for PTSD? (Hint: you've tried this stuff)

CBT, exposure therapy, group and family therapy, eye movement desensitization and reprocessing (EMDR), and safety plans

When assessing the client in the cognitive realm, which one of the following questions do you ask yourself?

Can you follow what the client is saying?

When assessing the client in the cognitive realm, which one of the following questions do you ask yourself? Is the client dangerous to self or others? Is the affect appropriate to the situation? Can you follow what the client is saying? Who does the client interact with?

Can you follow what the client is saying?

Communication theorists believe somatization disorders most likely occur among clients who:

Cannot express feelings for fear of guilt and retribution.

The client presents in crisis center saying, "They didn't warn me. After 20 yrs. & they just walk in & say I no longer have a job." The client's personal counselor is ill & unavailable & the client's immediate family is away & unreachable by telephone. The nurse will interpret that a most significant reason that this client is in crisis is that the client

Cannot process the event with the usual support network

3. The general thrust of cognitive therapy is that emotional responses are largely dependent on automatic thoughts or core beliefs about situations or one's environment. After failing the first test, the student nurse thinks," I'll never be a nurse." What automatic thought does this statement represent

Catastrophic thinking.

When communicating with a client who has major depressive disorder, the nurse should avoid being:

Cheerful and outgoing

works may rhyme but not logical connection describes what positive symptom related to excessive speech pattern in schizophrenia?

Clanging

Which mental health team member is a registered nurse with specialized preparation in psychiatric-mental health nursing at the graduate level? Psychiatric-mental health nurse. Clinical specialist. Clinical psychologist. Psychiatrist.

Clinical specialist.

What 4 second generation antipsychotics can cause weight gain?

Clozaril (clozapine), Fluphenazine (Prolixin), Olanzapine (Zyprexa), Risperidone (Risperdal) cause weight gain

In which of the following therapies, which has been studied for the treatment of patients with borderline personality disorder, is mindfulness training a central component?

Cognitive behavior therapy

A client is participating in therapy that explores the effects of unrealistic thought patterns on daily life. Which type of therapy is the client likely engaging in?

Cognitive therapy techniques

A patient who is is admitted to the emergency room with a serious knife wound, asks the nurse, "Can you hear him?" There is no one in the room other than the patient and the nurse. When asking about hallucinations, what type would concern the nurse and increase the risk of suicide?

Command

What is the goal of the Industry vs. Inferiority stage of Erikson's theory

Competency (Direct energy to mastering knowledge and intellectual skills. Inferiority creates feelings of being incomplete and unproductive)

A client who admits to having frequent suicidal ideations is admitted to the psychiatric inpatient unit. During the assessment interview, the client says, "I don't really need to be here, I'm very much at peace with myself now." The nurse should interpret that the client probably:

Continues to be a significant risk for suicide.

A client who admits to having frequent suicidal ideations is admitted to the psychiatric inpatient unit. During the assessment interview, the client says, "I don't really need to be here, I'm very much at peace with myself now." The nurse should interpret that the client probably:

Continues to be significant risk for suicide

an adolescent client presents in emergency room with right arm paralysis. A complete diagnostic work up is completed, but no organic cause for the paralysis can be determined. The client tells the nurse, "I guess I have to miss my piano recital today" The nurse suspects the client may be experiencing:

Conversation disorder

An adolescent client presents in the emergency room with right arm paralysis. A complete diagnostic workup shows no organic cause of the paralysis. The client tells he nurse, " I guess I will have to miss my piano recital today." The nurse suspects the client may be experiencing

Conversion disorder

An adolescent client presents in the emergency room with right arm paralysis. A complete diagnostic workup is completed, but no organic cause for the paralysis can be determined. the client tells the nurse," I guess I have to miss my piano recital today. The nurse suspect the client may be experiencing:

Conversion disorder.

A client hospitalized for psychotic symptoms including auditory hallucinations and delusions of reference is prescribed a medication with a strong dopamine blocking action. The nurse teaches the client to recognize which symptom as a possible side effect of the medication? 1. Muscle stiffness 2. Constipation 3. Orthostatic intolerance 4. Dry mouth

Correct Answer: 1 Rationale 1: Dopamine is found in the basal ganglia and is responsible for control of complex movement. When these dopamine receptors are blocked, the client may experience muscle stiffness. A dry mouth and constipation are due to anticholinergic effects. Orthostatic intolerance is due to an anti-adrenergic effect.

A 15-year-old client was depressed due to the loss of the client's mother and was placed on venlafaxine (Effexor). Two weeks later the client returns to the clinic and says, "I am feeling worse and have no hope." What nursing action is a priority? 1. Assess for suicidality. 2. Ask what the client enjoys. 3. Assess if the client is sleeping at night. 4. Evaluate how the client's other family members are coping.

Correct Answer: 1 Rationale 1: In the initial treatment period, children and adolescents may carry an increased risk of suicidal ideation and behavior. It would be a priority to assess the client's current risk. The other items may be part of the client's assessment but would not be a life or death priority at this time.

The white blood cell count of the client on clozapine (Clozaril) is 2.8. What action should the nurse take? 1. Hold the medication and call the psychiatrist. 2. Administer the medication and monitor the next count. 3. Monitor the client for orthostatic hypotension. 4. Check to see if the thyroid levels are normal.

Correct Answer: 1 Rationale 1: Kills blood cells and they're immune deficient, so it's important to know what the WBC count and tell the psychiatrist!!!!!!! Agranulocytosis, a marked decrease in white blood cell counts, is a serious side effect of this medication. It should be held and stopped by the prescriber before the client gets a serious infection. Thyroid levels are not related to agranulocytosis and neither is orthostatic hypotension.

The client with schizophrenia is on olanzapine (Zyprexa) and has gained ten pounds in the four weeks after its initiation. The client asks the nurse if the weight gain is related to this medication. What nursing response is correct? 1. This medication is associated with weight gain in some clients. 2. The client is most likely gaining weight due to a hidden alcohol problem. 3. The client was evidently not weighed correctly initially. 4. The client is probably just feeling better and eating more. .

Correct Answer: 1 Rationale 1: The CAITIE study demonstrated that antipsychotics, especially olanzapine, can trigger significant weight gain in some clients. Although plausible as reasons for the weight gain/difference, the other choices are not as probable and negate the importance of monitoring weight in a client on olanzapine

The nurse is assessing the client for signs and symptoms of brain dysfunction. If the limbic system function is disrupted, you expect the client to have difficulty with: 1. Emotional responses. 2. Consciousness. 3. Vital life functions. 4. Auditory hallucinations.

Correct Answer: 1 Rationale: The limbic system, often referred to as the "emotional brain," is believed to be responsible for the experience and expression of emotion, as well as memory, and some aspects of attention. Consciousness is modulated by the reticular activating system. Many vital life functions are controlled by the medulla oblongata. Auditory hallucinations would arise from disruptions in the cerebral cortex.

A mental health nurse is reviewing the post-test responses for a staff educational session that the nurse provided on the chronological development of psychiatric medications. Which of the following responses would indicate the participants understood the information correctly? Standard Text: Select all that apply. 1. The newer antidepressants, the SSRI group, have fewer side effects than the older antidepressants. 2. The effectiveness of antidepressants has led to research resulting in a better understanding of brain biochemistry. 3. The discovery of chlorpromazine (Thorazine) dramatically changed psychiatric treatment. 4. Few new psychiatric medications are needed due to the large number of safe and effective current medications. 5. Each new type of psychiatric medication was developed due to a focus on a specific psychiatric illness and not due to chance.

Correct Answer: 1,2,3,5 Rationale 1: The newer antidepressants, the SSRI group, have fewer side effects than the older antidepressants. The SSRI do not have the dietary restrictions with the risk of hypertension crisis as the MAOIs do. The tricyclic antidepressants have more side effects than do the SSRIs.

A nurse in the inpatient unit says to the client, "I want to speak to you about the drugs you are taking, particularly the antipsychotic ones." After the client walks away without interacting, the nurse asks another nurse for suggestions. Which of the following would help the nurse improve this interaction? Standard Text: Select all that apply. 1. Use the word medication instead of drugs. 2. Explain that you want to talk "with" the client not "to" the client. 3. Set up an appointment with the client at least a day in advance of the discussion. 4. State the name of the medication instead of the word antipsychotic. 5. Have the psychiatrist speak with the client about medications since this is not a nursing role.

Correct Answer: 1,2,4 Rationale 1: Not gunna set up an apt because you might not be avaiable the day before to make the appointment. Use the word medication instead of drugs. The word drugs often connotes negative images of illegal drug use. The word medication is used in the treatment of people with physical illnesses as well as mental illnesses.

In reviewing the history of a client on risperidone (Risperdal), the nurse notes that no previous diagnosis is available. The nurse knows that the newer atypical antipsychotic medications are commonly given for which of the following syndromes? Standard Text: Select all that apply. 1. Dementia with psychotic features 2. Schizophrenia 3. Antisocial personality disorder 4. Attention deficit disorder 5. Bipolar I disorder

Correct Answer: 1,2,5 Rationale 1: Dementia with psychotic features. Atypical antipsychotic medications are used to treat the behavioral and psychotic features of dementia. Rationale 2: Schizophrenia. Atypical antipsychotic medications treat psychotic symptoms in disorders such as schizophrenia. Rationale 3: Antisocial personality disorder. Antisocial personality disorders due not respond to antipsychotic medications. Rationale 4: Attention deficit disorder. Atypical antipsychotic medications are not useful for attention deficit disorder, which is often treated with stimulants. Rationale 5: Bipolar I disorder. Atypical antipsychotic medications are used to treat bipolar mania.

The client with depression was started on flurazepam (Dalmane) and looks very tired after breakfast. What factors should the nurse assess related to the client's tiredness? Standard Text: Select all that apply. 1. If the client has felt hung-over from this medication in the past 2. If the client's blood pressure is elevated 3. If the client's TSH level is low 4. The level of the client's depression 5. The length and quality of the client's sleep

Correct Answer: 1,4,5 Rationale 1: If the client has felt hung-over from this medication in the past. This medication can cause a hung-over effect. Rationale 2: If the client's blood pressure is elevated. An elevated blood pressure is often asymptomatic and does not typically cause fatigue. Rationale 3: If the client's TSH level is low. A low TSH would indicate a hyperactive thyroid and not cause fatigue. Rationale 4: The level of the client's depression. The client might have fatigue associated with depression. Rationale 5: The length and quality of the client's sleep. The length and quality of the client's sleep should be assessed to determine the effectiveness of the medication flurazepam, used for the treatment of insomnia.

A family member tells the nurse that much information is available on the internet about medications. This family member asks the nurse to explain what neurotransmitters are impacted by lithium. Which nursing response is correct? 1. Lithium interacts with GABA and opens the chloride channels. 2. Lithium lowers the amount of serotonin and norepinephrine available in the neural synapses. 3. Lithium increases the amount of dopamine available at the postsynaptic receptor. 4. Lithium raises the norepinephrine levels in the neural synapse.

Correct Answer: 2 Rationale 1: Lithium lowers serotonin and norepinephrine. It lowers these neurotransmitters, this results in lower amounts of serotonin and norepinephrine available. Lithium does not interact with GABA and open chloride channels, does not increase the amount of dopamine available at the postsynaptic receptor, and does not raise the norepinephrine levels in the neural synapse.

When focusing on psychobiology, what is most important for the client's family to understand? 1. The client's symptoms 2. The underlying neurobiology of behavior 3. The client's medication regimen 4. The client's phenotype

Correct Answer: 2 Rationale 1: Neurobiology, a patient's behavior, is the focus of psychobiology. Understanding the neurobiology of the client's behavior will help the family comprehend the rationale for treatment. It also places the client's illness in the same context as any other medical disorder. The phenotype is the expression of the genotype. The family will have to understand the client's medication regimen, but should have an understanding of why the medications were selected. Symptoms should be discussed in terms of neurobiology.

A client tells visiting family that a test was done to see how the client's brain was functioning. The family asks the nurse if there really is such a test. The nurse realizes that the client had which type of test? 1. Computerized tomography (CT) 2. Positron emission test (PET) 3. Single photon-emission computed tomography (SPECT) 4. Magnetic resonance imaging (MRI)

Correct Answer: 2 Rationale 1: A PET scan provides information about the metabolic functioning of the brain. CT, MRI, and SPECT are imaging techniques to examine the structure of the brain. A PET Scan shows you real time images of a brain, while an MRI takes a picture of your brain.

In preparing for the treatment of a client only on carbamazepine (Tegretol), the nurse plans for which of the following? 1. A client with auditory hallucinations 2. A client with mood instability or convulsions 3. A client with memory deficits 4. A client with alcohol withdrawal or delusions

Correct Answer: 2 Rationale 1: Some anticonvulsants are used in the treatment of mood instability. Antipsychotic medications treat hallucinations. Acetylcholinesterase inhibitors treat memory issues. Alcohol withdrawal symptoms are treated with benzodiazepines.

A nurse planning a staff education session would correctly explain the role of psychopharmacologic treatment as which of the following? 1. Decrease clients' worst symptoms so that they do not require long-term treatment. 2. Promote clients' physiologic stability so that they can grow holistically. 3. Stabilize clients so that they can participate in psychoanalysis. 4. Manage clients so that they are happy and do not have to endure the stresses of everyday life.

Correct Answer: 2 Rationale 1: The goal of psychopharmacology is to stabilize brain function, thus allowing clients to grow emotionally, in their relationships, and at their jobs or school. The goal should be more than just decreasing the worst symptoms. Psychoanalysis is only one form of psychotherapy. All people need to learn how to cope with the stresses of everyday life, and a medication does not make a person happy. It can improve brain function and decrease or eliminate depressive symptoms.

The client who was taking zaleplon (Sonata) took about an hour to fall asleep the first night after it was discontinued. The client asks the nurse if this means that the client is addicted to the medication. Which nursing response is correct? 1. There are no sedative-hypnotics that can be addictive. 2. This medication is not associated with withdrawal symptoms. 3. Usually the medication is tapered off over six weeks to prevent withdrawal. 4. The client is addicted, but withdrawal is mild.

Correct Answer: 2 Rationale 1: Sonata is a nonbenzo. Although this medication may cause some minor difficulty in falling asleep after it is discontinued, it is not associated with withdrawal symptoms. The medication does not need to be tapered off. The client is not addicted to the medication. The barbiturates and benzodiazepines can be addictive.

The mother of a client diagnosed with schizophrenia is tearful and wonders aloud if she passed the illness on to her child, and if her grandchild will also develop the disease. The nurse should reply with which statement? 1. "I see you are feeling upset. Do you want to talk?" 2. "Schizophrenia does have a strong genetic link, but at present there is no specific genetic test for it." 3. "Your grandchild has nothing to worry about." 4. "You and your child should volunteer for genetic research."

Correct Answer: 2 Rationale 1: Schizophrenia has an 80% chance of heritability. At present there is no specific genetic test available. Clients and families should be presented with information about the benefits of genetic research for future generations of people with schizophrenia. Telling the client there is nothing to worry about is false reassurance and is not therapeutic. Acknowledging the client's distress is appropriate, but the nurse must address the client's concerns directly.

The client asks the nurse how the SSRI antidepressant that the client is prescribed works. What nursing response is correct? 1. SSRIs work on depression by sedating the centers of the brain responsible for worrying. 2. SSRIs allow more of a chemical neurotransmitter, serotonin, to be available to areas of the brain. 3. SSRIs are stimulants that enhance the activity of the brain and pleasure centers. 4. SSRIs decrease the amount of norepinephrine available in the lower cortical areas.

Correct Answer: 2 Rationale 1: Selective serotonin reuptake inhibitors decrease the reuptake of serotonin from the neural synapse, thus allowing more to be present at the postsynaptic receptor site. SSRIs are selective for serotonin and do not lower norepinephrine. They are neither stimulants nor sedatives.

A woman calls the nurse at the mental health clinic about her husband who takes phenelzine (Nardil). She states that he took several over-the-counter decongestants and now has a stiff neck, headache, nausea, and vomiting. The nurse bases her response on what information? 1. Agranulocytosis is an adverse reaction that occurs due to the interaction of MAOIs and decongestants. 2. MAOIs can trigger a hypertensive crisis if taken with sympathomimetics. 3. Flu-like symptoms are common when clients begin taking MAOIs. 4. Neuroleptic malignant syndrome presents with muscular rigidity following the ingestion of MAOIs.

Correct Answer: 2 Rationale 1: When MAOIs are mixed with foods containing tyramine or sympathomimetics, a hypertensive crisis can occur that is heralded by the symptoms of headache, stiff neck, nausea, vomiting, and rising blood pressure. MAOIs, when not taken with foods containing tyramine or sympathomimetics, are not associated with flu-like symptoms. Agranulocytosis is demonstrated by a low white blood cell count and can occur following the initiation of antipsychotic medications. Neuroleptic malignant syndrome is an adverse reaction to antipsychotic medications.

The nurse evaluates which of the following client statements as validation that the teaching on lithium was effective? 1. I will restrict fluids to 100 ml per eight hours. 2. I will quit taking lithium if I get depressed. 3. I will have my blood levels checked every two to three months. 4. I will have liver function tests every six months.

Correct Answer: 3 LITHIUM HAS A NARROW THERAPUTIC RANGE Rationale 1: Lithium levels are drawn every two to three months and after increases. If fluid is restricted to the point of dehydration, toxicity can occur. Lithium is a mood stabilizer and treats mania and Bipolar symptoms and, therefore, would not be stopped during depression. Liver function tests are not needed for lithium since it is an ion and not metabolized by the liver.

An involuntary client being treated for an acute exacerbation of paranoid schizophrenia refuses the morning dose of medication. The nurse is frustrated and wonders if the client will ever develop insight. What aspects of psychobiology could help reframe the client's behavior for the nurse? 1. The client is not responsible for the behavior. 2. Adhering to the client's medication regimen is a priority to the nursing care. 3. The frontal and parietal lobe involvement in schizophrenia can cause an unawareness of the illness or the need to take medications. 4. The client's brain chemistry is altered and medications will help.

Correct Answer: 3 Rationale 1: Acknowledging the psychobiology aspects of the client's illness will explain why it is not possible for the client to maintain insight during the exacerbation of the illness. Knowing that the client's illness will respond to medications does not address the nurse's frustration. It is important to know why the client is not responsible for his behavior.

When the nurse reviews the effectiveness of the client's lithium level, the nurse should take into account which of the following client factors? 1. Marital status 2. Gender 3. Ethnicity 4. Weight

Correct Answer: 3 Rationale 1: Because of differing metabolic rates, the therapeutic range of lithium differs among Asian, African- American, and Caucasian groups. Weight, gender, and marital status would not impact the effectiveness of the medication.

The nurse and a client are discussing the diagnosis of depression. The client asks, "Where in my brain does the depression come from?" The nurse is aware that: 1. The occipital lobe governs perceptions of events, judging them as positive or negative. 2. The parietal lobe has been linked to depression. 3. The limbic system is thought to be the emotional center of the brain. 4. The medulla regulates key biological and psychological activities.

Correct Answer: 3 Rationale 1: The limbic system is thought to be the emotional center of the brain. The parietal lobe has not been linked to depression. The medulla does regulate key biological activities, but not psychological activities. The frontal lobe, not the occipital lobe, governs perceptions of events, judging them as positive or negative.

A member of the client's family tells the nurse that they don't understand the choice of electroconvulsive therapy (ECT) for their mother's depression. The family member states they are worried about the damage her brain will incur from the grand mal seizure. What will the nurse teach the family members about ECT? 1. Grand mal seizures are not life threatening. 2. They can withdraw consent at any time. 3. ECT is a safe and effective treatment option for depression. 4. The induced seizure lasts less than a minute.

Correct Answer: 3 Rationale 1: The priority information for the family is that ECT is a safe treatment option, but is only used as the LAST RESORT IN TREATMENT. The nurse can inform the family that ECT currently uses muscle relaxants and short-acting anesthetic agents during the procedure. The family should then be told that the ECT-induced seizure causes no tissue damage or neuronal cell loss. Most ECT clients report positive associations and relief from depression. And finally, the family should be informed that consent for the procedure is given by the client and the consent can be withdrawn at any time.

Because venlafaxine (Effexor) increases norepinephrine, the nurse assesses for what symptom in the client, especially when the client is on the higher doses of this medication? 1. Sedation 2. Hypothermia 3. Bradycardia 4. Elevated blood pressure

Correct Answer: 4 Rationale 1: Drugs that increase Free Norepinephrine are SNRIs. Norepinephrine effects your fight or flight system. Activation of your fight or flight can increase blood pressure and cause tachycardia. The impact of norepinephrine on the sympathetic nervous system increases the risk of hypertension. Bradycardia, hypothermia, and sedation would not occur when the sympathetic nervous system is activated.

A new nurse in a psychiatric program tells the charge nurse "I'm not sure I feel safe working with all of these crazy people." Select the best reply by the charge nurse. 1. "Don't worry, you'll get used to it." 2. "Believe me, it is not safe to work with some of these clients." 3. "Maybe you should consider transferring to a medical-surgical floor." 4. "It sounds like you need to discuss your feelings with the clinical supervisor."

Correct Answer: 4 Rationale 1: Developing self-awareness of one's own dualistic issues is essential to providing professional, competent, and quality care. Dismissing these concerns, agreeing with them, or advising a transfer are not strategies that will promote the new nurse's self-awareness.

The client reports that the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications? 1. Paroxetine (Paxil) 2. Methylphenidate (Ritalin) 3. Zolpidem (Ambien) 4. Olanzapine (Zyprexa)

Correct Answer: 4 Rationale 1: Olanzapine is an antipsychotic medication used to treat psychotic symptoms such as hallucinations. Methylphenidate is a stimulant used to treat attention deficit disorder. Paroxetine is an antidepressant, while zolpidem is for insomnia. Paxil is an SSRI pine = Atypical pine second generation antipsychotic (Tip at the top of the pine) Ambien is for sleep Zyprexa is an antipsychotic

A client is administered the dexamethasone suppression test (DST), which attempts to assess the hypothalamic- pituitary-adrenal (HPA) axis. How will the results of the test be used? 1. To identify genetic predisposition 2. To diagnose psychiatric illness 3. To identify appropriate treatment 4. To identify pathology in the HPA axis function

Correct Answer: 4 Rationale 1: The results of the DST are not diagnostic of the illness, but suggest some pathology in the HPA axis function. The DST does not identify genetic predisposition or treatment options.

A client is hospitalized for psychotic symptoms including auditory hallucinations and paranoid delusions. Based on an understanding of neurobiology, the nurse knows the psychotic symptoms arise from disruptions in which neurotransmitter? 1. Norepinephrine 2. Serotonin 3. Acetylcholine 4. Dopamine

Correct Answer: 4 Rationale: Dopamine disruptions are involved in psychosis. Serotonin and norepinephrine are associated with mood disorders. Acetylcholine is associated with dementia of the Alzheimer's type.

The client with bipolar disorder, who is on Divalproex, asks the nurse why the psychiatrist ordered an anticonvulsant when the client has no history of seizures. 1. Clients with bipolar disorder are at increased risk of having seizures and are treated to prevent them. 2. Divalproex is not an anticonvulsant; it is an antipsychotic medication. 3. The client must be on another medication that lowers the seizure threshold and the Divalproex is protective. 4. Several anticonvulsant medications, including Divalproex, are used as mood stabilizers.

Correct Answer: 4 TREATS BIPOLAR TWO! Rationale 1: A number of anticonvulsant medications are mood stabilizers. Clients with bipolar disorder are not at increased risk of having seizures; however, abrupt withdrawal of anticonvulsant medications may trigger seizures. Divalproex is an anticonvulsant. There is no data to support that the client is on another medication; Divalproex is used as a mood stabilizer for this client, not as an anticonvulsant.

An individual is subjected to chronic uncontrollable stress. What will be the effect on the client's neuroendocrine function? 1. Hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis and release of substance P 2. Hypoactivity of the hypothalamic-pituitary-adrenal (HPA) axis and release of dopamine 3. Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and release of dopamine 4. Hyperactivity of the hypothalamic-pituitary-adrenal (HPA) axis and release of substance P

Correct Answer: 4 Rationale 1: Substance P is neuropeptide thought to be released during physiologic and environmental stress. Substance P is thought to contribute to changes in the central nervous system that predispose individuals to anxiety and depression.

A nurse new to psychiatry asks her colleague why the newer antipsychotic medications do not cause as many EPSEs as do the conventional antipsychotic medications. Which response, if made by the nurse, is correct? 1. The newer antipsychotics also have a muscle relaxing effect that masks the EPSEs. 2. The newer antipsychotics do not impact dopamine. 3. The newer antipsychotics only act in the lower extrapyramidal dopamine pathways. 4. The newer antipsychotics have less affinity for dopamine receptors and also bind to serotonin receptors.

Correct Answer: 4 Rationale 1: The conventional antipsychotic medications have a greater affinity for the dopamine receptors, and occupancy of the dopamine receptors above 80% leads to EPSEs. The newer antipsychotic medications have less affinity for dopamine and some affinity for serotonin, both of which reduce the risk for EPSE. The newer antipsychotics do not have a muscle relaxing effect and must work in the higher dopamine pathways to be effective.

Which teaching need is important when a client is newly prescribed buspirone (Buspar) 5 mg tid?

Correct encourage to the client to take the medication continually as prescribed because onset action is delated 2-3 weeks

Which of the following would be the most important considerations when evaluating an individual for a personality disorder?

Culture

The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the teams decision? A. No previous admissions for major depressive disorder B. Vital signs stable; no psychosis noted C. Able to comply with a safety contract; able to problem-solve life issues D. Able to participate in a plan for safety; family agrees to constant observation

D What should you review with your patient concerning suicide prior to discharge instead of a contract? ANS: A safety plan

Staff has made several verbal attempts to de-escalate a client, however, the client's level of agitation continues to increase and it becomes necessary to administer a fast-acting pharmacological intervention. Which medication would the nurse most likely provide? Answers:

D. Haloperidol (Haldol).

A normal phenomenon that may surface and inhibit effectiveness in any phase of the 1:1 relationship: A. Resistance B. Countertransference C. Acting out D. Transference

D. Transference

What is the goal of the Initiation vs. Guilt stage of Erikson's theory

Decision making and purpose (Face challenges that require active, purposeful, responsible behavior. Guilt occurs if the child is irresponsible and made to feel too anxious.)

belief that action are controlled by another person or force is what type of positive schizophrenia delusion?

Delusions of control

A pervasive, excessive, & unrealistic need to be cared for is characteristic of which of the following personality disorders?

Dependent personality disorder

A pervasive, excessive, and unrealistic need to be cared for is characteristic of which of the following personality disorders?

Dependent personality disorder

A pervasive, excessive, and unrealistic need to be cared for is characteristic of which of the following personality disorders?

Dependent personality disorder.

If a nurse subscribes to the theory that learned helplessness is a major factor in the development of depression, which statement would support that belief?

Depression develops when a person believes he or she is powerless to effect change in a situation.

A client admitted for multiple suicide attempts after failing relationships, complains during group therapy that she, " always falls for the bad guy." The nurse knows the type of group therapy that will be most beneficial for this client is:

Dialectical behavioral therapy

What would the nurse expect to find when assessing a client with OCPD?

Difficulty completing projects

What would the nurse expect to find when assessing a client with obsessive-compulsive personality disorder?

Difficulty completing projects

What would the nurse expect to find when assessing a client with obsessive-compulsive personality disorder?

Difficulty completing projects.

Which of the following interventions would the nurse implement to address the patient with feelings of abandonment?

Discuss talking about feelings of abandonment without acting out feelings in group therapy sessions.

During visiting hours, a client who is angry at her ex-husband's charges of child neglect express this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism?

Displacement

The following describes which dissociative disorder? A dissociative process usually trauma induced results in a sudden identity disturbance owing to the inability to recall important personal information is:

Dissociative amnesia

What anticonvulsant can cause birth defects such as spina bifida?

Divalproex (Valproic Acid, sodium valproate)

What pathway in the brain is effected in schizophrenia?

Dopamine (DA) pathway

Antipsychotic drugs work on ________ receptors.

Dopamine receptors

Your psych patient is experiencing erratic movements, involuntary movements, Parkinsonian, and NMS. What scale should you use to assess if this patient has Extrapyramidal Syndrome (EPS)?

EPS can be assessed with "AIMS", the abnormal involuntary movement scale

repeating words of self and others describes what positive symptom related to excessive speech pattern in schizophrenia?

Echolalia

The ability to see beyond outward heavier and understand from pt's point of view is which of the following? Genuineness. Transference. Empathy. Countertransference.

Empathy.

Which teaching need is important when a client is newly prescribed buspirone (Buspar) 5 mg tid?

Encourage the client to take the medication continually as prescribed because onset of action is delayed 2-3 weeks.

Which teaching need is important when a client is newly prescribed buspirone (Buspar) 5 mg tid? -Encourage the client to avoid drinking alcohol while taking this medication because of the additive CNS depressant effects. -Encourage the client to take the medication continually as prescribed because onset of action is delayed 2-3 weeks. -Encourage the client to monitor for signs and symptoms of anxiety to determine the needs for additional buspirone (Buspar) prn. -Encourage the client to be compliant with monthly lab tests to monitor for medication toxicity.

Encourage the client to take the medication continually as prescribed because onset of action is delayed 2-3 weeks.

dyskinesia, dystonia, and Parkinsonian are indicators of what severe side effect of Psych Medications?

Extrapyramidal Syndrome (EPS)

During a client admission, it is important for the nurse to obtain the family history for mental disorders because: -A positive history of mental disorders signifies the client will have those disorders. -Family history may assist in decisions about diagnosis and treatment. -Clients may be embarrassed about family history and withhold information. -Discussing family history will help prevent client from getting the disorder.

Family history may assist in decisions about diagnosis and treatment

During a client, admission it is important for the nurse to obtain the family history for mental disorders because:

Family history may assist in decisions about dx. & treatment

5. The nursing history and assessment of an adolescent with conduct disorder might reveal all of the following behaviors EXCEPT:

Feelings of guilt associated with the exploitation of others

1. A mental health worker asks nurse to describe how crisis intervention works, which is best

Find a solution not an immediate and overwhelming problem

What were the contributions of Florence Nightingale to psychiatric nursing?

Florence instrumental in looking at emotional and physical concerns (Although it is true that in the context of her time she emphasized the physical environment, Nightingale was among the first to note that the influence of nurses on their clients goes beyond physical care and has psychological and social components)

What 2nd generation antipsychotic is given IM, is long-lasting, and helps with non-adherence?

Fluphenazine (Prolixin)

Pre-Frontal Cortex (PFT) is the area of brain responsible for

Focusing one's attention. Predicting the consequences of one's actions; anticipating events in the environment. Impulse control; managing emotional reactions. Planning for the future.

What is the goal of the Intimacy vs. Isolation stage of Erikson's theory

Form intimate relationships. Health friendships lead to intimacy, otherwise isolation may result

Which of the following medications, if given concurrently with lithium, could produce a toxic effect?

Furosemide (Lasix).

Which of the following medications, if given concurrently with lithium, could produce a toxic effect? Insulin. Prednisone. Digoxin (Lanoxin). Furosemide (Lasix).

Furosemide (Lasix).

A client says to the nurse, "Everything makes me anxious now." The nurse knows that free- floating anxiety is a common theme in:

Generalized anxiety disorders.

A client says to the nurse, "Everything makes me anxious now." The nurse knows that free-floating anxiety is a common theme in:

Generalized anxiety disorders.

What is the goal of the Generativity vs. Stagnation stage of Erikson's theory

Generativity is achieved through helping the younger generation develop and lead useful lives.

The nurse's ability to be open, honest, & renal in interactions with clients is described by which characteristic that enhances the achievement of the nurse-client relationship?

Genuineness

When you are open, honest and real in interactions with the patient, you are exhibiting which of the following? Genuineness. Transference. Empathy. Countertransference.

Genuineness.

What food interacts with most medications?

Grapefruit interacts w/ a lot of these medications!

How can you tell if Bupropion (Wellbutrin) or Effexor (venlafaxine) are causing serotonin syndrome?

HTN and tachycardia

What medication might have a reversable side effect of parkinsonian syndrome, like pill rolling or lack of associated movements?

Haldol

What is the fastest acting antipsychotic?

Haldol (haloperiodol)

Akathisia, aka restlessness, prolactinoma aka lactation are side effects of what psychiatric medication?

Haldol, aka Haloperidol

What antipsychotic is often given in the ER to aggressive patients because it is fast-acting?

Haldol, aka Haloperidol

Staff has made several verbal attempts to D escalate a client, however, the clients level of agitation continues to increase and it becomes necessary to administer a fast acting pharmacological intervention. Which medication with the nurse most likely provide?

Haloperidol (Haldol)

Staff has made several verbal attempts to de-escalate a client, however, the client's level of agitation continues to increase and it becomes necessary to administer a fast-acting pharmacological intervention. Which medication would the nurse most likely provide? Methylphenidate (Ritalin). Lithium carbonate (Lithobid). Amitryptiline (Elavil). Haloperidol (Haldol).

Haloperidol (Haldol)

A client is exhibiting sedation, auditory hallucination, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5 mg tid and benztropine (Cogentin) 2 mg bid. Which statement about these medications is accurate? Haloperidol (Haldol) would assist the client to decrease grandiosity. Haloperidol (Haldol) would assist the client with dystonia. Benztropine (Cogentin) would assist the client with auditory hallucinations. Benztropine (Cogentin) would assist the client with sedation.

Haloperidol (Haldol) would assist the client to decrease grandiosity

A client is exhibiting sedation, auditory hallucination, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5 mg tid and benztropine (Cogentin) 2 mg bid. Which statement about these medications is accurate?

Haloperidol (Haldol) would assist the client to decrease grandiosity.

Staff has made several verbal attempts to de-escalate a client, however, the client's level of agitation continues to increase and it becomes necessary to administer a fast-acting pharmacological intervention. Which medication would the nurse most likely provide?

Haloperidol (Haldol).

Staff has made several verbal attempts to de-escalate a client however the client's level of agitation continues to increase & it becomes necessary to administer a fast-acting pharmacological intervention. Which medication would the nurse most likely provide?

Haloperiodol (Haldol)

The nurse is assessing a patient diagnosed with obsessive-compulsive disorder. The nurse realizes that in this disorder, the patient

Has an obsession which is the intrusive thought that cannot be dismissed from consciousness

The nurse is assessing a patient diagnosed with obsessive-compulsive disorder. The nurse realizes that in this disorder, the patient

Has an obsession which is the intrusive thought that cannot be dismissed from consciousness

The nurse is assessing a pt. with OCD. The nurse realizes that in this disorder, the pt

Has an obsession which is the intrusive thought that cannot be dismissed from consciousness

The student nurse realizes that individuals who self-mutilate may:

Have experienced childhood abuse & have difficulty processing feelings

The student nurse realizes that individuals who self-mutilate may:

Have experienced childhood abuse and have difficulty processing feelings.

The student realizes that individuals who self-mutilate may:

Have experienced childhood abuse and have difficulty processing feelings.

Which behavior would be most characteristic of a young man dx. as having antisocial personality disorder?

Having committed a crime, persuade the judge to suspend the sentence & later violate probation

Which behavior would be most characteristic of a young man diagnosed as having an antisocial personality disorder?

Having committed a crime, to persuade the judge to suspend the sentence and later violate probation.

*Why do we do dosage adjustments on anti-depressants?

Help correct signs and symptoms, not because of tolerance

3 parts of the limbic system

Hippocampus, Amygdala, Diencephalon (HAD)

A family member asks the nurse, " I think my sister needs more medication because she cannot sit still and her legs are moving constantly." The client's dosage of haloperidol (Haldol) was recently increased. What is the correct nurse response?

I will check with your sister because what you are describing sounds like a side effect called akathisia.

A family member asks the nurse, " I think my sister needs more medication because she cannot sit still and her legs are moving constantly." The client's dosage of haloperidol (Haldol) was recently increased. What is the correct nurse response? -I will see what medication has been prescribed to counteract the dystonic reaction she is having. -I will call the practitioner and report that your sister is developing tolerance to the Haldol and the dose is not effective. -I will check with your sister because what you are describing sounds like a side effect called akathisia. -I will check to see what your sister is prescribed for anxiety.

I will check with your sister because what you are describing sounds like a side effect called akathisia.

A family member asks the nurse, " I think my sister needs more medication because she cannot sit still and her legs are moving constantly." The client's dosage of haloperidol (Haldol) was recently increased. What is the nurse response?

I will check with your sister because what you are describing sounds like a side effect called akathisia.

and a family member ask the nurse, "I think my sister needs more medication because she cannot sit still and her legs are moving constantly." The clients dosage of haloperidol (Haldol) was recently increased. What is the correct nursing response?

I will check with your sister because what you are describing sounds like a side effect called akathisia.

Because Schizophrenia can cause memory problems, what mode of medication is best for these patients?

IM injections are good bc they last 4-6 week

Guidelines relating to "duty to warn" state that the professional should consider taking action to warn a third party when the client does which of the following ?

Identifies a specific intended victim.

When should you assess a patient who is taking antidepressants for signs and symptoms of suicide?

If patient present with hopelessness and worsening signs and symptoms of depression after taking anti-depressant

The nurse should monitor for which of the following in the pt. taking venlafaxine (Effexor):

Increased blood pressure

The nurse should monitor for which of the following in the client taking venlafaxine (Effexor)?

Increased blood pressure.

The nurse should monitor for which of the following in the client taking venlafaxine (Effexor)? Prolonged QTc interval. Increased weight. Increased blood pressure. Tardive dyskinesia.

Increased weight

A voluntary patient mutilates herself whenever she leaves the unit. The nurse suggests the use of 4-point restraint (restraining the patient's arms and legs to a bed in an isolation room) to prevent the patient from further harming herself. What question should be considered before this action is taken.

Is this the least restrictive measure possible?

A voluntary patient mutilates herself whenever she leaves the unit. The nurse suggests the use of 4-point restraint (restraining the patient's arms and legs to a bed in an isolation room) to prevent the patient from further harming herself. What should be considered before this action is taken.

Is this the least restrictive measure possible?

A voluntary pt. mutilates herself whenever she leaves the unit. The nurse suggests the use of 4-point restraint (restraining the pt.'s arms & legs to a bed in an isolation room) to prevent the pt. from further harming herself. What question should be considered before this action is take

Is this the least restrictive measure possible?

Which of the following is the most important factor in assessment of a suicide plan?

It the method & weapon easily available?

5. Client is blind w/ no physiological cause, but just witnessed a traumatic fatal fire. The client doesn't appear to be anxious or stressed. What is client demonstrating

La Belle Indifference

A client is blind with no physiological validation that since the client witnessed a fatal fire seven days ago. The client does not appear anxious even though it is impossible for implementing activities of daily living. The nurse determines the client is demonstrating:

La belle indifference

Communication theorists believe somatization disorders most likely occur among clients who:

Lack appropriate coping skills

A client has had a lack of concern over a right-hand paresthesia that developed abruptly after being caught cheating on an exam by the teacher. The paresthesia ended abruptly as well. Which symptom is most closely related to la belle indifference?

Lack of concern about the paresthesia.

A client states that she has a plan to commit suicide. The priority assessment at this time is :

Lethality of the method and availability of means

You are a nurse assigned to a unit where the majority of the clients have a personality disorder. You would expect that the treatment of personality disorder is:

Likely to be resistant because of the inflexibility of the behavioral patterns

Your patient is nauseous, vomiting, is having vision changes, ataxia, and tinnitus. What are you concerned they are developing?

Lithium toxicity

which known teratogenic effects can be caused by the common psychotropic medication divalproex and lithium?

Lithium- Epstein anomaly; Divalproex- spina bifida

Which known teratogenic effects can be caused by the common psychotropic medications divalproex and lithium ? Divalproex- Epstein anomaly; lithium- cleft palate Lithium- Epstein anomaly; divalproex-spina bifida Divalproex- limb malformations; lithium-seizure disorder Lithium-spina bifida; divalproex- mental retardation

Lithium- Epstein anomaly; divalproex-spina bifida

Which known teratogenic effects can be caused by the common psychotropic medications divalproex and lithium ?

Lithium- Epstein anomaly; divalproex-spina bifida"

A patient with schizophrenia approaches the nurse and says, "Cats eat birds...east now... job is new... you father." This speech pattern can be assessed as: Loose associations. Expressing delusions. Hyperverbosity Circumstantiality.

Loose associations

A patient with schizophrenia approaches the nurse and says, "cats eat birds... East now... Job is new... You father." this speech pattern can be assessed as:

Loose associations

thinking is characterized by speech in which ideas shift from one unrelations subject to another describes what positive symptom related to excessive speech pattern in schizophrenia?

Loose associations

A patient with schizophrenia approaches the nurse and says, "Cats eat birds...east now... job is new... you father." This speech pattern can be assessed as:

Loose associations.

Nardil (Phenelzine) and Parnate(Tranylcypromine) are what type of medications?

MAOIs

What medication can't be taken with in 2weeks of SSRI or SNRI because they can cause Serotonin Syndrome?

MAOIs

Parnate and Nardil are both:

MAOIs, and you need to avoid tyramine including soy sauce

2. variance between affect and interaction, what does the nurse suspect

Malingering • Present w/ condition for secondary gain •

An 18 year-old client who joined the military after graduating from high school is admitted to the mental health unit for depression and suicidal ideation. He tells the nurse the military is not what he expected and he wants to go home. The nurse observes a variance in his affect between his interactions with fellow clients and staff. The nurse suspects:

Malingering.

The hospitalist's admission note mentions that the 75 year old patient has sundown syndrome. The nurse expects the patient will:

Manifest confusion and agitation after the sunsets at night.

The hospitalist's admission note mentions that the 75 year old patient has sundown syndrome. The nurse expects the patient will: Exhibit chronic fatigue. Be more tired and lethargic at night. Manifest confusion and agitation after the sunsets at night. Be more alert between 6 pm and 11 pm.

Manifest confusion and agitation after the sunsets at night.

Of the following, who has the lowest risk of suicide? Single. Divorced. Married. Never married. Widowed.

Married.

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for:

Memory impairment

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for:

Memory impairment.

Of the following, which die by suicide more often? Men. Women.

Men. (male gender are at risk to die by suicide, although women have more attempts)

what type of therapy expects patients to be on time for scheduled activities, sets limitations and encourages their patients to face the realities of life in the here and now?

Milieu therapy

Calmness, respect, care for one's self and others, intellectual management, and caritas are all aspects of what type of nursing care?

Milieu therapy.

What type of therapy is described below: "The psychiatric-mental health registered nurse provides, structures, and maintains a safe and therapeutic environment in collaboration with patients, families, and other health care clinicians."

Millieu therapy P. 25 Standards of Practice

At what level of anxiety can a patient's learning still occur, but will not be optimal due to a decreased attention span and ability to concentrate?

Moderate

While completing the nursing admission of a pt. admitted to the general hospital for surgery, the nurse observes that the pt. is experiencing anxiety at the

Moderate level

A veteran from the Iraq war is diagnosed with post-traumatic stress disorder (PTSD). He is hospitalized after swallowing a handful of his antianxiety medication. His physical condition is stabilized in the ED, and he is transferred to the inpatient psychiatric unit. In developing an initial plan of care, which is the priority of care that the nurse selects for him?

Monitor suicidal risk

A veteran from the Iraq war is diagnosed with posttraumatic stress disorder. He is hospitalized after swallowing a handful of his anti-anxiety medication. His physical condition is stabilized in the ED, he is transferred to the inpatient psychiatric unit. In developing an initial plan of care, which is the priority of care that the nurse selects for him?

Monitor suicidal risk

To understand & participate in therapeutic communication the nurse understands which of the following:

More than half of all message communicated are nonverbal

What is negative transference in a one-to-one relationship?

Negative feelings toward the nurse based on the patient's background (In negative transference , the client shows a number of reactions based on forms of hate (hostility, loathing, bitterness, contempt, annoyance). Although there are both positive and negative aspects to every transference, a predominantly negative transference is uncomfortable for both you and the client.)

A cognitive therapy tool that helps a client visualize the negative outcomes of a poor decision is:

Negative imagery

A cognitive therapy tool that helps a client visualize the negative outcomes of a poor decision is:

Negative imagery.

incomprehensible language is characteristic of persons with schizophrenia. Client is telling you about his hallucinations of Indians on the wind calling out to them "ipeechee." you offer the client a drink of water and the client says "emanah" if in your assessment you discover that the client made up these words, they are good examples of which of the following:

Neologism

invention of new word by client describes what positive symptom related to excessive speech pattern in schizophrenia?

Neologism

Incomprehensible language is characteristic of persons with schizophrenia. A client is telling you about his hallucinations of Indians on the wind calling out to them "ipeechee." You offer the client a drink of water and the client says "emanah." If in your assessment you discover that the client made up these words, they are good examples of which of the following:

Neologisms.

Incomprehensible language is characteristic of persons with schizophrenia. A client is telling you about his hallucinations of Indians on the wind calling out to them "ipeechee." You offer the client a drink of water and the client says "emanah." If in your assessment you discover that the client made up these words, they are good examples of which of the following: Incoherence. Tangentiality. Neologisms. Word salad.

Neologisms.

What severe side effect of Psych Medications is a life threatening reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, diaphoresis, rapid deterioration?

Neuroleptic Malignant Syndrome (NMS)

The therapeutic action of psychotropic drugs is most often caused by their affect on the activity of:

Neurotransmitters

The therapeutic action of psychotropic drugs is most often caused by their effect on the activity of: The cerebellum. Dendrites. Neurotransmitters. The peripheral nervous system.

Neurotransmitters

The therapeutic action of psychotropic drugs is most often caused by their effect on the activity of:

Neurotransmitters.

Can patients taking antidepressants become tolerant to their meds and need an increase?

No, dosage adjustment has nothing to do with tolerance

Which is more reliable, verbal or non-verbal communication?

Non-verbal.

The nurse assesses a client with the admitting diagnosis of bipolar disorder, mania. The symptom presented by the client that requires the nurse's immediate intervention is the client's:

Nonstop physical activity

Which mental health team member is a registered nurse with specialized preparation in psychiatric-mental health nursing at the graduate level? Psychiatric-mental health nurse. Nurse practitioner. Clinical psychologist. Psychiatrist.

Nurse practitioner.

The contribution of Florence Nightingale that remains a part of contemporary nursing practice is the idea that:

Nurse should consider psychological and social components of care as well as the physical

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective, yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct

Often people of Asian extraction have a lower metabolic rate and need lower amounts of medication.

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective, yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

Often people of Asian extraction have a lower metabolic rate and need lower amounts of medication.

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

Often people of Asian extraction have lower metabolic rates & need lower amounts of medication

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

Often people of Asian extraction have lower metabolic rates and need lower amounts of medication.

The client of Asian extraction asks the nurse why the client's own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct? -Often people of Asian extraction have lower metabolic rates and need lower amounts of medication. -There is no correlation between ethnic background and the amount of medication someone receives. -People of European extraction have more side effects from medication that do those of Asian extraction. -People of Asian extraction have higher express emotionality leading to better prognosis and lower dosages.

Often people of Asian extraction have lower metabolic rates and need lower amounts of medication.

The client reports the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications

Olanzapine (Zyprexa)

The client reports the medication must be effective since the hallucinations are now markedly diminished. The nurse documents that the client is responding positively to which of the following medications? Methylphenidate (Ritalin) Divalproex (Depokote) Paroxetine (Paxil) Olanzapine (Zyprexa)

Olanzapine (Zyprexa)

What 2nd generation antipsychotic is used in schizophrenia and is available as an injectable?

Olanzapine (Zyprexa)

Why does too high a dose of antipsychotics cause parkinsonianism?

Parkinsons issue is with too much dopamine, that's the reason why you get parkinsons issues with psychosis because you're giving someone a bunch of dopamine.

which of the following medications would be used to treat a client who is experiencing ritualistic behavior that interferes with job performance and activities of daily living?

Paroxetine (Paxil)

Which of the following medications would be used to treat a client who is experiencing ritualistic behavior that interferes with job performance and activities of daily living?

Paroxetine (Paxil).

Which of the following medications would be used to treat a client who is experiencing ritualistic behavior that interferes with job performance and activities of daily living? Fluphenazine (Prolixin). Paroxetine (Paxil). Lorazepam (Ativan). Carbamazepine (Tegretol).

Paroxetine (Paxil).

3. Which of the following treatment regimens would most appropriately be ordered for a client with PTSD

Paroxetine and group therapy

Group therapy is effective for adolescents because:

Peer support & values are important elements to an adolescent

What boundaries are used for an individual to define themselves? Personal Boundaries. Social boundaries. Material boundaries.

Personal boundaries.

What is positive transference in a one-to-one relationship?

Positive feelings toward the nurse based on the client's background. (Positive transference —that is, positive feelings for the therapist— occurs when the client generally has had satisfying past relationships with significant others during childhood)

A 22 year old male patient is diagnosed with schizophrenia,. The nurse notes that he is often forgetful and seems disinterested in activities. Furthermore, he has difficulty completing tasks. The nursing planning of care will address strategies based on the understanding that these behaviors are due to A lack of self-esteem. Problems in cognitive functioning. Shyness and embarrassment Manipulative tendencies

Problems in cognitive functioning

A 22 year old male patient is diagnosed with schizophrenia,. The nurse notes that he is often forgetful and seems disinterested in activities. Furthermore, he has difficulty completing tasks. The nursing planning of care will address strategies based on the understanding that these behaviors are due to :

Problems in cognitive functioning.

The Rorschach (inkblot) test and the Blackie pictures are examples of Objective personality tests. Projective personality tests. Intelligence tests. Cognitive function tests.

Projective personality tests

The Rorschach (inkblot) test and the Blackie pictures are examples of:

Projective personality tests.

A psychiatric pt. has greatly increased seemingly non-goal-directed motor activity & seems terror-sticken. He does not respond to nursing staff efforts to calm him. He is noted to have distorted perceptions & disordered thoughts. The intital intervention of highest priority is:

Provide for the pt. safety

Which mental health team member is a registered nurse with specialized preparation in psychiatric-mental health nursing? Psychiatric-mental health nurse. Clinical specialist. Nurse practitioner. Clinical psychologist. Psychiatrist.

Psychiatric-mental health nurse.

Which mental health team member is a medical physician whose specialty is mental disorders? Psychiatric-mental health nurse. Nurse practitioner. Clinical psychologist. Psychiatrist.

Psychiatrist.

The symptoms of "flashbacks" is a manifestation of which of the following psychological states?

Psychosis

The symptoms of "flashbacks" is a manifestation pf which of the following psychological states?

Psychosis

Discharge plans are developed for a client who requires some assistance with improving decision making & socialization post-discharge. What type of program might be included in the discharge plans?

Psychosocial clubhouse

What are the desirable Outcomes for anxiety disorders?

Pt will be able to tolerate mild anxiety, safety during panic attack

The client who has been taking buspirone (Buspar) for one month returns to the clinical for a follow- up assessment. The nurse determines that the medication is effective if the absence of which manifestation occurs: Paranoid thought process. Rapid heartbeat or anxiety. Alcohol withdrawal symptoms. Thought broadcasting or delusions.

Rapid heartbeat or anxiety

The client who has been taking buspirone (Buspar) for one month returns to the clinical for a follow- up assessment. The nurse determines that the medication is effective if the absence of which manifestation occurs:

Rapid heartbeat or anxiety.

A client was quite upset the entire time she was pregnant and made it clear that she did not want her unborn child. However, since the birth, she has become overly protective and refuses to let anyone else near the infant. What ego defense mechanism does the nurse recognize in the client's behavior?

Reaction formation (When something you fear occurs, you have the opposite reaction bc you're afraid to feel the feels or you aren't confident that you can control your fears.)

After completing a third electroconvulsive therapy treatment, a patient says, "I haven't been able to remember anything since the last treatment, it wasn't like this last time." The nurse's best response is to;

Reassure the pt. that most pts. who receive this type of therapy experience some temporary loss of memory

If the hippocampus is damaged, you would expect the person to have difficulty with: Recalling previously learned information. Monitoring sensory input. Maintaining blood pressure. Maintaining consciousness.

Recalling previously learned information

If the hippocampus is damaged, you would expect the person to have difficulty with:

Recalling previously learned information.

The client who has panic attacks whenever he sees waterfalls because he witnessed the death of his friend, who fell while climbing above the waterfall, may benefit from the feature of cognitive and behavioral treatment of:

Reframing his irrational belief that he could have prevented the fall.

God, devil, messianic mission is what type of positive schizophrenia delusion?

Religious

Bonus: Soon after ECT, a patient is most likely to have problems with which one of the following items on the Mini-Mental Status Examination?

Reporting the date

Soon after ECT (Electro convulsive therapy), a patient is most likely to have problems with which one of the following items on the Mini-Mental Status Examination?

Reporting the date

What part of the brain is responsible for arousal, wakefulness and sleep regulation? Amygdala. Thalamus. Hypothalamus. Reticular Activating System.

Reticular Activating System.

What 2nd generation antipsychotic is used to treat schizophrenia, bipolar, mood, hallucinations?

Risperidone (Risperdal)

Bupropion (Wellbutrin), Effexor (venlafaxine) are what type of psychiatric medication?

SNRIs

* Your patient is experiencing obsessive thoughts and participating in ritualistic actions. What medication do you prescribe?

SSRI

*What is the treatment of choice for OCD?

SSRI

What Meds are commonly prescribed for patients with PTSD?

SSRI (ex) Zoloft, anxiolytics for panic attacks, antihypertensives like propranolol, clonidine, minipress for reducing nightmares

Paroxetine (Paxil) type of drug and what does it treat?

SSRI used for OCD and PTSD

Paxil (Paroxatine) and Zoloft (Sertaline) are what type of medications?

SSRIs

What medications allow more serotine to be available in brain by inhibiting uptake of serotonin?

SSRIs

_____ medications are the first line of treatment for depression, OCD, and PTSD psychiatric disorders.

SSRIs

The client asks the nurse how SSRI antidepressant that is prescribed works. What nursing response is correct? -SSRIs are stimulants that enhance the activity of the brain and pleasure centers. -SSRIs decrease the amount of norepinephrine available in the lower cortical areas. -SSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain. -SSRIs work on depression by sedating the centers of the brain responsible for worrying.

SSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain

The client asks the nurse how SSRI antidepressant that is prescribed works. What nursing response is correct?

SSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain.

The client asks the nurse how SSRI antidepressant that prescribed works is. What nursing response is correct

SSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain.

benzo can cause dependency, so always assess pt. who will be prescribed benzos for anxiety for ____

SUD

Where do seretonin and dopamine come from in the brain?

Sara and Ralf are friends (Serotonin in the Ralphi) Dope N (Dopamine in the niagra)

*Your patient is exhibiting loss of interest, is vegetative (anorexia, social withdrawal, fatigue, low energy), has suicidal ideation, excessive guilt, and psychomotor retardation. What psych issue are they likely experiencing?

Seasonal affective disorder

Do second or first generation antipsychotics have less EPS side effects?

Second Generation Atypical have less EPS side effects than first generation

Symptoms of dissociative identity disorder DID, include all of the following except:

Secondary gain of increased attention by not remembering actions or behaviors

The client who has panic attacks whenever he sees waterfalls because he witnessed the death of his friend, who fell while climbing above the waterfall, may benefit from the feature of cognitive and behavioral treatment of :

Seeking social supports to help him grieve.

If Nardil (Phenelzine) and Parnate(Tranylcypromine) can cause what serious complication when taken with an SSRI or SNRI?

Serotonin Syndrome

What severe side effect of Psych Medications involves agitation, tachycardia, HTN, loss muscle coordination, confusion and can lead to seizure?

Serotonin Syndrome

At what level of anxiety can effective learning no longer occur due to the patient's extremely limited attention span and inability to concentrate or problem solve?

Severe (In severe anxiety a patient's thinking process is restricted, no education at this point, severe anxiety you understand that you are feeling stress, but there is no loss of contact with reality)

5. Which of the following may be influential in the predisposition to PTSD

Severity of the stressor and availability of support systems.

What were the contributions of Hildegard Peplau to psychiatric nursing?

She created the three phases of the nurse-client relationship: orientation, working, and termination phase. This was also what the one-to-one relationship is based on. (Peplau principles are based on anxiety, interpersonal relationships with phases (initial, etc) Published book "Interpersonal Relations in Nursing" framework of psych nursing Preached interpersonal nature of nursing and need to understand psychodynamic and counseling techniques)

The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. What is the most appropriate nursing intervention?

Show respect that is not based on the client's behavior. (Even if someone is icky, smelly, and can't get out of bed you still need to show them unconditional positive regard)

Discharge instructions to a patient who is diagnosed with bipolar type two disorder, emphasizes the importance of:

Sleep hygiene

What symptom common to other anxiety disorders is NOT a symptom of PTSD?

Sleepiness is not a symptom, they are more "on alert"

What type of boundaries are established within a culture and define how an individual is expect to behave in social situations? Personal Boundaries. Social boundaries. Material boundaries.

Social boundaries.

false beliefs about body functions is what type of positive schizophrenia delusion?

Somatic

Bupropion (Wellbutrin) and Effexor (venlafaxine) can cause serotonin syndrome if combined with what over the counter medication?

St. John's Wart

A nurse is caring for a client with a terminal illness. The client asks if the nurse will pray with the client for the remission of the cancer. The nurse does not practice the same religion and does not believe that a remission is possible as this stage of the disease. The nurse should:

Stand silently for a few moments while the client prays.

A nurse is caring for a client with a terminal illness. The client asks if the nurse will pray with the client for the remission of the cancer. The nurse does not practice the same religion and does not believe that a remission is possible as this stage of the disease. The nurse should: Call the Chaplain and set up a referral for the client's spiritual distress. Encourage the client to go ahead, but leave the room while the client prays. Stand silently for a few moments while the client prays. Gently confront the client about unrealistic expectations that the cancer is going to regress.

Stand silently for a few moments while the client prays.

The major feature of intellectual developmental disorder is:

Sub average intellectual functioning (IQ below 70)

1. The major feature of intellectual developmental disorders is:

Sub average intellectual functioning (IQ below 70).

mistaken identify (ex) pt. sees nametag is Student Nurse but believes you are President is what type of positive schizophrenia delusion?

Substitution

Which of the following statements about clients who are suicidal is least accurate?

Suicidal clients are usually ambivalent about dying and have fantasies of rescue.

What is the third most common cause of death for teenagers? Homicide. Cancer. Suicide. Accidents.

Suicide. (45-54 years old have highest rate of suicide (according to book chapter 16), 3rd leading cause of death in teenagers is suicide)

The concept of "good me, "Bad me", "not me" was explicated by which of the following theorist?

Sullivan

The concept of "good me, "bad me", and "not me" was explicated by which of the following theorists:

Sullivan's (Sullivan's interpersonal theory)

Ms. W. goes to the mood disorders clinic at the urging of her mother. The practitioner who examines her tells the nurse, "She's hypomanic." The nurse can expect to assess:

Symptoms less severe than a manic state

How is Schizoaffective Disorder different than full schizophrenia?

Symptoms of psychosis and mood disorder but doesn't quite meet criteria for full schizophrenia

2. Which of the following is true regarding diagnosis of adjustment disorder

Symptoms will likely remit once the pt has accepted the changes that precipitated the difficulties with adjustment

Which antidepressant should not be given to suicidal patients?

TCAs are highly lethal OD, so do not given them to suicidal patients

What severe side effect of Psych Medications involves facial movements, tapping feet, smacking/sucking lip, sticking out tongue

Tardive Dyskinesia (TD)

Which of the following would be the nurse suspect when observing that a patient with schizophrenia is tapping his feet, smacking his lips, and blinking and contorting his face as he speaks to another patient? Neuroleptic malignant syndrome Tardive dyskinesia Torticollis Parkinson's syndrome

Tardive dyskinesia

Which of the following would be the nurse suspect when observing that a patient with schizophrenia is tapping his feet, smacking his lips, and blinking and cortorting his face as he speaks to another patient?

Tardive dyskinesia

which of the following would be the nurse suspect one observing that a client with schizophrenia is tapping his feet, smacking his lips, and blinking and contouring his face as he speaks to another patient?

Tardive dyskinesia

Which of the following would be the nurse suspect when observing that a patient with schizophrenia is tapping his feet, smacking his lips, and blinking and contorting his face as he speaks to another patient?

Tardive dyskinesia,

How do we choose a medication?

Target symptoms, then we look at SEs, previous responses, family member response, prescriber's experienced

"Evaluate goal attainment, ensure therapeutic relationship closure" is the goal of which of the following phases of the therapeutic relationship? Orientation. Working. Termination.

Termination

The nurse-patient relationship has three stages. Which stages is described in the example below? "Progress has been made towards goals, a plan for continued care, feelings expressed about termination"

Termination phase (stages of the nurse-patient relationship Page 28)

The nurse and the client are discussing the diagnosis of depression. The client asks, "where in my brain does the depression come from?" The nurse is aware that:

The Limbic system is thought to be the emotional center of the brain

A client admitted to the medical surgical unit with a brain tumor. The nurse can anticipate that the client with the tumor in the frontal lobe's will have problems with:

The ability to think and plan

A client is admitted to the medical-surgical unit with a brain tumor. The nurse can anticipate that a client with a tumor in the frontal lobes will have problems with:

The ability to think and plan.

The part of the brain which is responsible for movement, posture, and balance is:

The cerebellum

The part of the brain which is responsible for movement, posture, and balance is

The cerebellum.

The part of the brain which is responsible for movement, posture, and balance is The midbrain. The brain stem. The cerebellum. The hypothamalus.

The cerebellum.

A client tells the nurse, "My doctor thinks my problem may lie with the neurotransmitters in my brain. What are neurotransmitters? "

The chemical messengers that cause brain cells to turn on or off.

A client tells the nurse, "My doctor thinks my problem may lie with the neurotransmitters in my brain. What are neurotransmitters? " -The chemical messengers that cause brain cells to turn on or off. -Small clumps of cells that alert the other brain cells to receive messages. -Tiny areas of the brain that are responsible for controlling our emotions. -Web-like structures that provide connection among various parts of the brain.

The chemical messengers that cause brain cells to turn on or off.

A client tells the nurse, "my doctor thinks my problem may lie with the neurotransmitters in my brain. What are neurotransmitter's? "

The chemical messengers that caused brain cells to turn on or off.

5. A client is voluntarily admitted to the psychiatric unit. The nurse knows this means:

The client gave informed consent for hospitalization.

which of the following constitutes criteria for involuntary hospitalization?

The client has threatened family members

Which of the following constitutes criteria for involuntary hospitalization?

The client has threatened family members.

in assessing a client for the MMSE, you ask the client the meaning of the proverb, "people who live in glass houses shouldn't throw stones." The client replies " because it will break." The correct interpretation of this finding is:

The client is likely a child who demonstrates Piaget's concrete operational thinking

In assessing a client for the MMSE, you ask the client the meaning of the proverb, "People who live in glass houses shouldn't throw stones." The client replies, "Because it will break." The correct interpretation of this finding is :

The client is likely a child who demonstrates Piaget's concrete operational thinking.

In assessing a client for the MMSE, you ask the client the meaning of the proverb, "People who live in glass houses shouldn't throw stones." The client replies, "Because it will break." The correct interpretation of this finding is : -Client has a probable mood disorder -Client has limited intellectual ability -Client has a probable anxiety disorder -The client is likely a child who demonstrates Piaget's concrete operational thinking.

The client is likely a child who demonstrates Piaget's concrete operational thinking.

Your client with intense suicidal ideation has been hospitalized for 1 week, during which time he has received a selective serotonin reuptake inhibitor (SSRI). He reports "no change" in suicidal ideation, although he demonstrates a wider range of affect and takes more initiative in self-care. The team is considering his imminent discharge. It is essential to consider which of the following factors?

The client may have enough energy to plan and complete a suicide attempt.

The client is recently diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?

The client misses therapy appointments and stays at home for fear of being in a place that the client cannot escape

The client is recently diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?

The client misses therapy appointments and stays at home for fear of being in a place that the client cannot escape.

The client is recently diagnosed with agoraphobia. Which behavior wuld be most characteristic of this disorder?

The client misses therapy appointments and stays at home for fear of being in a place that the client cannot escape.

Which of the following client behaviors would indicate a need for further intervention in the anxious patient on a benzodiazepine?

The client requesting a higher dose of drug to achieve the intended effect.

Which of the following client behaviors would indicate a need for further intervention in the anxious patient on a benzodiazepine? -The client relying more on coping skills and taking less medication -The client requesting a higher dose of drug to achieve the intended effect. -The client asking to be taken off the medication gradually. -The client asking about behavior methods for anxiety control.

The client requesting a higher dose of drug to achieve the intended effect.

which of the following client behaviors would indicate a need for further intervention in the anxious patient on a benzodiazepine?

The client requesting a higher dose of drug to achieve the intended effect.

The nurse is working with a client who has been diagnosed with a personality disorder. What situation has described the client's external response to stress?

The client tried to change the environment instead of changing him or herself.

Which outcome should the nurse expect from a client with social isolation related to fear of rejection?

The client will actively participate in unit activities by discharge

which of the following serves as the foundation for the Scope of Nursing Practice and the Standards of Professional Nursing Practice?

The definition of nursing

The nurse and client are discussing the diagnosis of depression. The client asks, "Where in my brain does the depression come from? The nurse is aware that:

The limbic system is thought to be the emotional center of the brain.

The nurse and client are discussing the diagnosis of depression. The client asks, "Where in my brain does the depression come from? The nurse is aware that: -The occipital lobe governs the perceptions of events, judging them to be positive or negative. -The parietal lobe has been linked to depression. -The limbic system is thought to be the emotional center of the brain. -The medulla regulates key biological and psychological activities.

The limbic system is thought to be the emotional center of the brain.

Define the following phenomena as it relates to one-to-one relationships: Countertransference

The nurse's personal biases effect the nurse-patient relationship (Countertransference is suspected when the nurse repeatedly assigns meaning to the nurse-client relationship that belongs to the nurse's other relationships. In countertransference, the psychiatric-mental health nurse's ability to assess nurse-client interactions becomes confused or thwarted by unresolved conflicts. Ex: dressing suggestively, blushing, or giggling when client makes sexual remark, sarcasm in response to a client's concern, offering reassurance by putting hand on client's shoulder.)

as a client with mental illness is discharged from the facility the nurse invites the patient to a birthday party for a staff psychologist. Select the correct analysis of this scenario:

The nurses action blurs the boundaries of the therapeutic relationship

What is a Dexamethasone suppression test?

The overnight dexamethasone suppression test checks to see how taking a steroid medicine called dexamethasone changes the levels of the hormone cortisol in the blood. This test checks for a condition in which large amounts of cortisol are produced by the adrenal glands (Cushing's syndrome)

Does the term "Transference" refer to the patient or the nurse?

The patient.

nurse G is assessing a patient who gives the impression of being anxious. Nurse G6 to validate this impression because anxiety is:

The subjective experience of the individual

In educating the family, what would you teach regarding the negative symptoms of psychiatric disability?

These symptoms should not be confused with laziness or manipulation.

In educating the family, what would you teach regarding the negative symptoms of psychiatric disability? These symptoms should not be confused with laziness or manipulation. Generally these symptoms are under the control of the client. These symptoms are temporary and will disappear in 2 - 6 months. Negative symptoms can be understood as "bad" or "inappropriate behavior."

These symptoms should not be confused with laziness or manipulation.

What is the difference between a suicide gesture and suicide attempt?

They are interchangeable

belief that thoughts are heard is what type of positive schizophrenia delusion?

Thought broadcasting

agencies, people are putting thoughts into client's head is what type of positive schizophrenia delusion?

Thought insertion

The nurse should monitor for all of the following for the client taking clozapine (Clozaril) EXCEPT:

Thyroid functions.

The nurse should monitor for all of the following for the client taking clozapine (Clozaril) EXCEPT: Seizure activity. Thyroid functions. Significant weight gain. Drooling

Thyroid functions.

What is the primary reason a person might exhibit cutting?

To cope with trauma and process feelings (Self-mutilation is a way to process feelings, cutting can be described as bringing the pain to the surface, coping with trauma)

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision tinnitus & tremors. The lithium level is 2.5 mEq/L. The nurse nterprets this level as:

Toxic

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5mEq/L. The nurse interprets this level as:

Toxic

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5mEq/L. The nurse interprets this level as: Toxic Normal. Slightly below normal. Excessively below normal.

Toxic

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5mEq/L. The nurse interprets this level as:

Toxic .

4. A involuntary patient has the right to refuse to take medication.

True

A client who has been on lithium therapy for six mo. Has developed symptoms of mild arthritis. He tells the nurse that he wants to start taking Advil for his pain. Which of the following is nurse's best response:

Tylenol would be a better choice because Advil will ^ Lith. level

A young client frequently engages in high risk behaviors, including driving at high speeds, drinking in excess, and engaging in high risk sexual behaviors. it is more important for the nurse assessing the client to recognize that there is high probability that:

Unconscious thoughts of suicide are present

The nurse is working with a client and family. When planning care, the nurse will consider principles underlying psychobiological research including which of the following concepts?

Understanding the role of neurotransmitters in the formation of behavior is valuable to nursing care.

The nurse is working with a client and family. When planning care, the nurse will consider principles underlying psychobiological research including which of the following concepts? The brain is relatively unchangeable after birth. The brain is unresponsive to the environment. Mental illness is primarily considered to be a consequence of environment. Understanding the role of neurotransmitters in the formation of behavior is valuable to nursing care.

Understanding the role of neurotransmitters in the formation of behavior is valuable to nursing care.

Psychoanalysts believe that behavior problems in adulthood are caused by:

Unresolved issues in early development stages

Your client with a personality disorder informs you, "A novice like you couldn't possibly help me. What I need right now is to leave this hospital." What is your best initial response?

What are you experiencing right now?

Which of the following is part of the ongoing nursing assessments of the client on psychiatric medications? Select all that apply.

Whether the medication is causing side effects How well the medication is managing the client's symptoms

What is the goal of the Autonomy vs. Shame & Doubt stage of Erikson's theory

Will and independence (18mo to 3yrs: Begin asserting independence. Realize their will and discern their behavior is their own. Shame and doubt occur if restrained too much or punished too harshly.)

Which outcome is most realistic and appropriate in planning care for the newly diagnosed client with an anxiety disorder?

Within 1 month, the client will experience decreased frequency of episodes.

A community mental health nurse works in a low-income health clinic in large urban area. Almost 25% of the female clients are diagnosed with mood disorders. Among the male clients, only 7% have a similar diagnosis. Epidemiological studies indicate the:

Women have higher rates of affective disorders than men

Of the following, which attempt suicide more often? Men. Women.

Women. (male gender are at risk to die by suicide, although women have more attempts)

"Promote client change" is the goal of which of the following phases of the therapeutic relationship? Orientation. Working. Termination.

Working

The nurse-patient relationship has three stages. Which stages is described in the example below? "Maintain trust, promote patient's insight of reality, problem-solving, continual observation"

Working phase (Problem solving doesn't start in the first phase, and while promotion of the patient occurs right away, observation occurs only in the working phase. stages of the nurse-patient relationship Page 28)

1. Which of the following individuals is at highest risk for a suicide attempt? a. A client who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me." b. A client who has been seeing a doctor for chronic, intractable pain and is taking pain medication. c. An American Indian client who just graduated from high school with honors. d. A physician who reports feeling "burnt out" and is considering retirement.

a

11. A client asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? a. "What do you think would be best for you to do?" b. "Of course you should. Marriage has to be based on truth." c. "Of course not. That would only make things worse." d. "I can't tell you what to do. You have to decide for yourself."

a

2. A client says to the nurse, "I've been offered a promotion, but I don't know if I can handle it." The nurse replies, "You're afraid you may fail in the new position." This is an example of which therapeutic technique? a. Restating b. Making observations c. Focusing d. Verbalizing the implied

a

3. A staff nurse on a surgical unit is the leader of a newly established group of staff nurses organized to determine ways to decrease the number of medication errors occurring on the unit. At each meeting, he addresses the group to convince the members to adopt his ideas. Which type of group and style of leadership is described in this situation? a. Task group, autocratic leadership b. Teaching group, autocratic leadership c. Self-help group, democratic leadership d. Supportive-therapeutic group, laissez-faire leadership

a

3. Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a. Neurosis b. Psychosis c. Depression d. Bereavement

a

4. Anna, who is 72 years old, is at the age when she may have experienced several losses in a short time. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity

a

7. A psychiatric nurse has been asked to lead an educational group on anger management for patients admitted to the psychiatric unit. Which of these actions by the nurse is the most important priority? a. Provide information and handouts on anger management. b. Ask patients how long they would like the group to last. c. Restrict the group to only those who have been complying with unit rules and expectations. d. Ask the patients if they would rather have a group on something else.

a

7. One of the goals of a therapeutic milieu is for clients to become more independent and accept self-responsibility. Which of the following approaches by staff best encourages the fulfillment of this goal? a. Including client input and decisions into the treatment plan b. Insisting that each client take a turn leading a group activity c. Making decisions for the client regarding plans for treatment d. Requiring that the client bathe, dress, and attend breakfast on time each morning

a

7. The nurse identifies the primary nursing diagnosis for a client as Risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis? a. The client has experienced no self-harm. b. The client sets realistic goals. c. The client expresses some optimism and hope for the future. d. The client has reached a stage of acceptance in the loss of the relationship.

a

8. A client states to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse? a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will feel better in time."

a

8. A depressed client who has been unkempt and untidy for weeks comes to group therapy today wearing makeup and a clean dress with hair washed and combed. Which of the following responses by the nurse is most appropriate? a. "I see you have put on a clean dress and combed your hair." b. "You look wonderful today!" c. "I'm sure everyone will appreciate that you have cleaned up for the group today." d. "Now that you see how important it is, I hope you will do this every day."

a

9. A client who has arrived at the health clinic for diabetic education is perspiring, wringing his hands, and states, "I'm so anxious about giving myself shots I can hardly breathe. I don't know what to do." Which of these actions by the nurse demonstrates good clinical judgment? a. Assist the client in relaxation exercises before commencing diabetes education. b. Instruct the client that it is not hard to give oneself a shot and commence teaching. c. Assess the client further for symptoms of anxiety. d. Cancel diabetic education and encourage the client to reschedule when he feels less anxious.

a

A client is being discharged from the inpatient psychiatric unit and states to his primary nurse, "Everyone abandons me and now you're probably going to abandon me, too." Which of these actions by the nurse best accomplishes termination of the therapeutic relationship? a. Discuss the boundaries of this relationship and assist the client to explore his feelings. b. Terminate the therapeutic relationship while exploring ways to remain connected as friends. c. Provide discharge medication instructions and encourage the client to follow up with his physician. d. Assure the client that he is not being abandoned and remind him that he can return to the unit in the future.

a

7. A client comes to the mental health clinic with reports of anxiety and depression. Regarding the transactional model of stress and adaptation, which of the following are important nursing actions when assessing his complaints? (Select all that apply.) a. Evaluate the client's perception of precipitating events. b. Ask the client about past stressors and degree of positive coping abilities. c. Assess the client's existing social supports. d. Evaluate the client's physical strength. e. Monitor the client's temperature.

a, b, c

3. The environment in which communication takes place influences the outcome of the interaction. Which of the following are aspects of the environment that influence communication? (Select all that apply.) a. Territoriality b. Density c. Dimension d. Distance e. Intensity

a, b, d (Territoriality, density, and distance are aspects of the environment that communicate messages. Territoriality is the innate tendency to own space. Individuals lay claim to areas around them as their own. When an interaction takes place in the territory "owned" by one or the other, it often influences communication. Interpersonal communication can be more successful if the interaction takes place in a "neutral" area. For example, with the concept of territoriality in mind, the nurse may choose to conduct the psychosocial assessment in an interview room rather than in his or her office or the patient's room. Density refers to the number of people within a given environmental space. It has been shown to influence interpersonal interaction. Some studies indicate a correlation between prolonged high-density situations and certain behaviors, such as aggression, stress, criminal activity, hostility toward others, and a deterioration of mental and physical health. Distance is the means by which various cultures use space to communicate. Hall (1966) identified four kinds of spatial interaction, or distances, that people maintain from each other in their interpersonal interactions and the kinds of activities in which people engage at these various distances. Intimate distance is the closest distance that individuals will allow between themselves and others. In mainstream American culture, this distance, which is restricted to intimate interactions, is 0 to 18 inches. Personal distance is approximately 18 to 40 inches and reserved for personal interactions, such as close conversations with friends or colleagues. Social distance is about 4 to 12 feet away from the body. Interactions at this distance include conversations with strangers or acquaintances, such as at a cocktail party or in a public building. A public distance is one that exceeds 12 feet. Examples include speaking in public or yelling to someone some distance away. This distance is considered public space, and communicants are free to move about in it during the interaction.)

2. The nurse in the emergency department encounters a client who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all that apply.) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

a, c, d, e

5. A client who was sexually abused as a child is admitted to the inpatient psychiatric unit with a diagnosis of borderline personality disorder after a suicide attempt. She has refused to talk to anyone. Which of the following therapies might the IDT team recommend for this client? (Select all that apply.) a. Music therapy b. Art therapy c. Seclusion d. Electroconvulsive therapy

a,b

1. Which of the following are basic assumptions of milieu therapy? (Select all that apply.) a. The person owns his or her own environment. b. Each person owns his or her behavior. c. Peer pressure is a useful and powerful tool. d. Inappropriate behaviors are punished immediately.

a,b,c

2. On the milieu unit, duties of the staff psychiatric nurse include which of the following? (Select all that apply.) a. Medication administration b. Client teaching c. Medical diagnosis d. Reality orientation e. Relationship development f. Group therapy

a,b,d,e

In a psychiatric inpatient setting, the nurse observes an adolescent client's peers calling the client names. In this context, which statement by the nurses exemplifies the concept of empathy?

a. "I can see that you are upset. Can you tell me how you feel?"

You notice your client has a very tense body posture. What is your best response?

a. "I notice your fists are clenched. . .what's happening?"

Halfway through a 45-minute session with a nurse, the client is silent off and on for about 10 minutes. The nurse hypothesizes that the client may be experiencing resistance. Which of the following responses is most therapeutic?

a. "You have been silent for long periods during the last 10 minutes"

An instructor overhears the nursing student ask a client, "This is your third admission. Why did you stop taking your medications?" Which statement by the instructor would be appropriately related to the student's question?

a. "Your implied criticism and could have the effect of making the client feel defensive."

According to Maslow's hierarchy of needs, which client action would be considered most basic?

a. A client discusses the need for avoiding harm and maintaining comfort.

The nurse's ability to be open, honest, and real in interactions with clients is described by which characteristic that enhances the achievement of the nurse-client relationship?

a. Genuineness.

Which of the following treatment programs would be most appropriate for homeless clients whose judgement is severally impaired by paranoid delusions and command hallucinations due to medication nonadherence?

a. Inpatient hospital-based care

To understand and participate in therapeutic communication the nurse must understand which of the following:

a. More than half of all message communicated are nonverbal.

A psychiatric patient has greatly increased seemingly non-goal-directed motor activity and seems terror-stricken. He does not respond to nursing staff efforts to calm him. He is noted to have distorted perceptions and disordered thoughts. The initial intervention of highest priority is:

a. Provide for the patient's safety.

Discharge plans are being developed for a client who requires some assistance with improving decision making and socialization post-discharge. What type of program might be included in the discharge plans?

a. Psychosocial clubhouse.

The nurse and Mr. R. have had eight sessions. Mr. R. tells the nurse, "I got to the point that I was feeling pretty good, but now I'm beginning to get anxious again. I don't know if I'll be able to handle things on my own. Things feel uncertain, like they did when I left home to go to college." The nurse and Mr. R. most likely are entering which phase of the relationship?

a. Termination.

The nurse states to a client on the inpatient unit. "Tell me what's been on your mind?" What describes the purpose of this therapeutic technique?

a. To have the client initiate the conversation.

A client is being discharged from the inpatient psychiatric unit and states to the primary nurse, " Everyone abandons me and now you're probably abandoning me , too. " Which of these actions by the nurse best accomplishes termination of the therapeutic relationship? a. Discuss the boundaries of this relationship and assist the client to explore his feelings. b. Terminate the therapeutic relationship while exploring ways to remain connected as friends. c. Provide discharge medication instructions and encourage the client to follow up with his physician. d. Assure the client that he is not being abandoned and remind him that he can return to the unit in the future.

a. Discuss the boundaries of this relationship and assist the client to explore his feelings. (Being asked to give personal information—home address, telephone number, or being asked to see the client socially outside of the psychiatric setting. Realize that some clients have difficulty recognizing interpersonal boundaries. Explain to the client the difference between a social and a professional relationship and tell the client that yours is a professional relationship. Giving personal information or seeing the client socially would be a professional boundary violation.)

Frontal Lobe is the area of brain responsible for

ability to think and plan. planning, working memory, prioritizing tasks, problem solving

5 EPS Symptoms

acute dystonic reactions (bizaare/severe muscle rxns) tortocollis (can't move neck at all) Oculogyric crisis (Eyes roll into the back of the head - treat with benzotropine) Parkinsonian syndrome (dec meds or give anticholinergic) Akathisia (inability to sit still - treat by decreasing meds) Tardive dysconesia (treat by dec meds)

Benzodiazepines are used in the treatment of:

alcohol withdrawal & anxiety disorders

benzodiazepines are used in the treatment of

alcohol withdrawal an anxiety disorder

benzodiazepines are used in the treatment of:

alcohol withdrawal and anxiety disorder.

An individual may be considered gravely disabled for which of the following reasons;

all of the above

an individual may be considered gravely disabled for which of the following reasons:

all the above

classes of anti-depressant medication include all except the following:

anti-cholinergic

during a staff medication management class, the nurse discusses the use of antipsychotic medication to treat psychosis. Which of the following statement indicates how these medication's affect no transmitter activity:

anti-psychotics block dopamine receptors.

Classes of antidepressant medication include all except the following:

anticholinergics

Divalproex (Depokote) can cause what birth defects?

anticonvulsant that can cause spine abifida

Divalproex

anticovulsant used for bipolar II that causes birth defects like spina bifida

venlaxafine (Effexor) is a ________ psych drug

antidepressant (watch for suicidality w/i first few weeks)

Haldol, aka Haloperidol, is what class of medication and which disorder does it treat?

antipsychotic, , schizo for thinking, mood, and behavior

The nursing student working in the school health clinic completes the assessment of the 26-year-old student who is being screened for sexually transmitted disease. The young man shows a lack of concern about informing his sexual partners about his having an STD. Furthermore, he has a tough, menacing demeanor nd during the interview, he mentions his release from prison six months ago. His behaviors and attitudes are indicative of a personality disorder. Which of the following best characterizes this young man?

antisocial

6. Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to

anxiety

Hildegard Peplau's theory on interpersonal relationships in nursing includes the concept of?

anxiety

Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to

anxiety

which of the following questions with the nurse ask a woman to assess for hyperprolactinemia as a side effect of an antipsychotic medication?

are you having any discharge from your breasts?

A young client frequently engages in high-risk behaviors, including driving at high speeds, drinking an excess, and engaging in high-risk sexual behaviors. It is more important for the nurse assessing the client to recognize that there is high probability that:

arrested maturation is impairing judgment

A 15-year-old client was depressed due to loss of the clients mother and placed on Venlaxefine (effexor). two weeks later the client tells the nurse at the clinic that she feels "worse and have no hope." which nursing action is a priority?

assess for suicidality

Define what occurs during the Working phase of the nurse-patient relationship.

assisting the client with problem solving alternatives (stages of the nurse-patient relationship Page 28)

A client ask the nurse what to do about leaving the spouse the nurse replies, "why are you having trouble making a decision? It's easy to see you should file for a divorce." The nurse Manager overhearing the conversation with counsel the nurse because the nurses response:

assumes that the client is in capable of reaching an independent decision

A client ask the nurse what to do about leaving the spouse the nurse replies, "why are you having trouble making a decision? It's easy to see you should file for a divorce." The nurse Manager overhearing the conversation with counsel the nurse because the nurses response:

assumes that the client is in capable of reaching an independent decision (If your patient is hospitalized, they can't make decisions on their own, so in this situation, you can not assume the patient can file for divorce because they might not be able to make that choice right now.)

The clients medication she contains an order for sertraline hydrochloride (Zoloft). to ensure safe administration of the medication, the nurse would administer the dose:

at the same time each day after breakfast

What stage of erikson's development matches the following statement: "can i do things for myself or must i always rely on others to help me?"

autonomy vs. shame and doubt (18mo to 3yrs - develop sense of will and independance)

10. A client who was admitted to the psychiatric unit for major depressive disorder reports to the nurse, "Ever since my daughter died by suicide 10 years ago, I can't stand to be around my friends. They just don't get it!" Which of these actions by the nurse demonstrates good clinical judgment? a. Affirm that other people cannot possibly provide adequate support in circumstances like these. b. Assist the client to explore the connection between grief and anger. c. Tell the client that her friends are doing the best they can and she should try to accept their support. d. Ask the client to describe how her daughter killed herself.

b

10. A new client tells the nurse at the mental health clinic, "I was so stressed out after work today and trying to get to my appointment here on time that I started having chest pain." Which action by the nurse is a priority at this point? a. Offer the client antianxiety medication as prescribed. b. Assess the client's physical status including vital signs. c. Reinforce that since the client arrived on time there is nothing to worry about. d. Help the client to identify adaptive coping mechanisms for dealing with stress.

b

12. An adolescent who has just returned from group therapy is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? a. "What makes you think you will never have any friends?" b. "You're feeling pretty down on yourself right now." c. "I'm sure they didn't mean to hurt your feelings." d. "Why do you feel this way about yourself?

b

2. Why is stress management so important in one's overall health? a. Stress-related disorders strengthen the immune system. b. Sustained response to stress can increase vulnerability to a variety of diseases and maladaptive coping responses. c. Relaxation exercises are effective in preventing disorders such as depression and suicide. d. All of the above.

b

3. The nurse, who is an adult child of an alcoholic, is working with a client who abuses alcohol. The client has experienced a successful detoxification process and is beginning a rehabilitation program. He says to the nurse, "I'm not going to go to those stupid AA meetings. They don't help anything." The nurse, whose father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" The nurse's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries

b

4. Which of the following activities would be a responsibility of the psychiatric clinical nurse specialist on the IDT team? a. Manages the therapeutic milieu on a 24-hour basis b. Conducts group therapies and provides consultation and education to staff nurses c. Directs a group of clients in acting out a situation that is otherwise too painful for a client to discuss openly d. Locates halfway house and arranges living conditions for client being discharged from the hospital

b

4. Which of the following statements by a client are examples of adaptive coping mechanisms? a. "I like to take the edge off by having a few drinks." b. "I need to pay more attention to my calorie intake because I gained 10 pounds in the last month." c. "When the stress gets to be too much, I feel better after I kick the dog." d. "I try to stay away from people because it's less stressful than arguing with everybody."

b

5. A client reports hearing on last night's evening news that 25 people were killed in a tornado in south Texas, but appears to express no anxiety in response to this stressful situation. Which of these actions by the nurse is a priority? a. Ask where the client lives. b. Assess the client's perception about the relevance of this event. c. Encourage the client to use adaptive coping skills to help others through this tragedy. d. Ask where the client grew up.

b

5. Anna has been grieving the death of Lucky for 3 years. She is unable to take care of her normal activities because she insists on visiting Lucky's grave daily. What is the most likely reason that Anna's daughter has put off seeking help for Anna? a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to normalize behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors will think her mother is "crazy."

b

5. Success of long-term psychotherapy with a client (who attempted suicide following a break-up with her boyfriend) could be measured by which of the following behaviors? a. The client has a new boyfriend. b. The client has an increased sense of self-worth. c. The client does not take antidepressants anymore. d. The client told her old boyfriend how angry she was with him for breaking up with her.

b

6. A nurse has been asked to facilitate a group in the outpatient mental health clinic that is focused on helping patients problem-solve issues with adherence to medications. Which of these decisions about group size is most appropriate? a. The group should be open to all patients who express interest. b. The optimal size for this type of group is around 7 to 8 patients. c. Patients should democratically decide on the size of the group. d. The group should be limited to the first 35 patients who sign up.

b

6. In a medication education group, which of the following actions is most important for reinforcing the therapeutic milieu? a. Allowing each person a specific and equal amount of time to talk b. Reviewing group rules and interpersonal behavior expectations that apply to all clients c. Reading the medication information d. Restricting the group to only those clients who are currently adhering to medication schedules

b

7. A client states, "I refuse to shower in this room. I must be very cautious. The FBI has placed a camera in here to monitor my every move." Which of the following is the most therapeutic response? a. "That's not true." b. "I have a hard time believing that is true." c. "Surely you don't really believe that." d. "I will help you search this room so that you can see there is no camera."

b

7. A client with a history of schizophrenia is brought to the emergency department by police who report that she was knocking down food displays at a grocery store and yelling that the food is all poisoned. The client reports to the nurse the she has no idea why she was brought to the emergency department because "there is nothing wrong with me." Which of these actions by the nurse demonstrates good clinical judgment? a. Instruct the police officer that this client should be incarcerated because there is nothing that can be done in an emergency department. b. Document that the client is manifesting suspicious ideation and anosognosia. c. Ask the doctor to order gastric lavage because the client reports having been poisoned. d. Instruct the client that the food is not poisoned and there is something very wrong with her.

b

8. A client is admitted to the inpatient psychiatric unit, appears anxious, and states, "I've never been on a unit like this before." Which of these actions by the nurse is a priority for beginning to establish a therapeutic milieu? a. Instruct the client to remain in his room until he feels less anxious. b. Orient the client to the physical surroundings, milieu rules, and activities. c. Offer to medicate the client with antianxiety medication. d. Instruct the client not to worry because he will only be on the unit for a few days.

b

9, 11, 16 CHAPTER 9 1. A nurse who is leading a childbirth preparation group shows a film each week and sets out reading materials. She expects the participants to utilize their time on a topic of their choice or practice skills they have observed in the films. Which type of group and style of leadership is described in this situation? a. Task group, democratic leadership b. Teaching group, laissez-faire leadership c. Self-help group, democratic leadership d. Supportive-therapeutic group, autocratic leadership

b

9. A client with schizophrenia appears very watchful of others and tells the nurse, "There are infiltrators everywhere and I think they are trying to kill me." Which of these actions by the nurse would best promote development of trust with this client? a. Touch the client's shoulder and state, "I want you to feel safe here." b. State to the client, "I'm interested in hearing your thoughts. Would you like to talk more about this?" c. Ask the client, "Why would you think such a thing?" d. Tell the client, "It is an expectation that we will not talk about things that aren't real."

b

9. In determining the degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to be determined

b

9. The nursing supervisor asks one of the staff nurses to initiate a group with other staff nurses to identify new ways to prevent patient falls. Which of these would be the most appropriate style of leadership for the nurse to implement? a. Autocratic b. Democratic c. Laissez-faire d. Militaristic

b

4. The nurse says to a client, "You are being readmitted to the hospital. Why did you stop taking your medication?" What communication technique does this represent? a. Disapproving b. Requesting an explanation c. Disagreeing d. Probing

b (Probing: Persistent questioning of the patient and pushing for answers to issues the patient does not wish to discuss causes the patient to feel used and valued only for what information the nurse is seeking and may place the patient on the defensive Disapproving: Sanctioning or denouncing the patient's ideas or behavior implies that the nurse has the right to pass judgment on whether the patient's ideas or behaviors are "good" or "bad" and that the patient is expected to please the nurse.)

6. A client regularly develops nausea and vomiting when she is faced with a stressful situation. Which of the following should be considered when attempting to identify predisposing factors associated with Cindy's response? (Select all that apply.) a. Identify what happened right before she had the most recent episode of nausea and vomiting. b. Consider genetic influences. c. Identify any existing physical conditions that might make the client more vulnerable to respond in this way. d. Explore past experiences that may have resulted in this becoming a learned response.

b, c, d

10. A client who has been hospitalized following a suicide attempt is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions are most appropriate in this instance? (Select all that apply.) a. Restrict access to any item that might be harmful by placing the client in a seclusion room. b. Check on the client every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. c. Obtain an order from the physician to give the client a sedative to calm her and reduce suicide ideas. d. Do not allow the client to participate in any unit activities while she is on suicide precautions. e. Ask the client specific questions about her thoughts, plans, and intentions related to suicide.

b, e

2. Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the patient's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the patient from various sources e. Formulating nursing diagnoses and setting goals

b, e

A client on a psychiatric unit says, "It's a waste of time to be here. I can't talk to you or anyone." Which would be an appropriate therapeutic response?

b. "Are you feeling that no one understands?"

Open-ended questions and statements results in fuller, more revealing responses by the client and frequently stimulate discussion. Which of the following is an example of this technique by the nurse?

b. "Tell me about your family."

Which situation reflects the defense mechanism of projection?

b. A promiscuous wife accuses her husband of having an affair.

Hildegarde Peplau's theory on interpersonal relationships in nursing includes the concept of:

b. Anxiety.

A client asks the nurse what to do about leaving the spouse. The nurse replies, "Why are you having trouble making a decision? It's easy to see you should file for a divorce." The nurse manager overhearing the conversation would counsel the nurse because the nurse's response:

b. Assumes that the client is incapable of reaching an independent decision.

During the initial interview with a client, the nurse begins to feel uncomfortable and realizes the client's behaviors and mannerisms remind the nurse of the nurse's abusive parents. The nurse concludes that the current situation represents which phenomenon?

b. Counter-transference.

Selye referred to the body's response to stress as the:

b. General adaptation syndrome.

A student complains to the PMHNP at student health on campus that she has too much stress in her life. The psychiatric nurse practitioner tells her that the level of stress people experience depends primarily on?

b. How they appraise the events of life. ("Think happy thoughts and you will be happy")

The contribution of Florence Nightingale that remains a part of contemporary nursing practice is the idea that:

b. Nurses should consider psychological and social components of care as well as the physical.

Which of the following serves as the foundation for the Scope of Nursing Practice and the Standards of Professional Nursing Practice?

b. The definition of nursing.

which behavior would be most characteristic of an individual with narcissistic personality disorder?

belief that he is entitled to special privileges that others may not have

What is Divalproex (Valproic Acid, sodium valproate) used for?

bipolar

What should pregnant women know before taking lithium?

birth defects

What is the Age range for the Trust vs. Mistrust stage in Erikson's theory

birth to 18 months (infant)

Psychotropic drugs are any meds that affect _______

brain including neurotransmitters, mind, behavior, emotions

1. Three years ago, Anna's dog, Lucky, her pet for 16 years, was killed by a car. Since that time, Anna has lost weight, rarely leaves her home, and talks excessively about Lucky. Anna's behavior would be considered maladaptive for which of the following reasons? a. It has been more than 3 years since Lucky died. b. Her grief is too intense over the loss of a dog. c. Her grief is interfering with her functioning. d. Cultural norms typically do not comprehend grief over the loss of a pet.

c

10. A client, who has been in the hospital for 3 weeks, has used Valium "to settle her nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time but states to the nurse, "I don't know if I will be able to make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which is the most appropriate response by the nurse? a. "Why do you think you need drugs to deal with your problems?" b. "Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can." c. "Let's explore some things you can do to decrease your anxiety without resorting to drugs." d. "Just hang in there. I'm sure everything is going to be okay."

c

3. Elena has just received a promotion on her job. She is very happy and excited about moving up in her company, but she has been experiencing anxiety since receiving the news. The nurse accurately assesses her primary appraisal of the situation as which of the following? a. Benign-positive b. Irrelevant c. Challenging d. Threatening

c

3. Which of the following activities would be a responsibility of the clinical psychologist member of the IDT? a. Locates halfway house and arranges living conditions for client being discharged from the hospital b. Manages the therapeutic milieu on a 24-hour basis c. Administers and evaluates psychological tests that assist in diagnosis d. Conducts psychotherapy and administers electroconvulsive therapy treatments

c

4. A nurse leader is explaining about group "therapeutic factors" to members of the group. She tells the group that group situations are beneficial because members can see that they are not alone in their experiences. Which of the following therapeutic factors is the nurse describing? a. Altruism b. Imitative behavior c. Universality d. Imparting of information

c

5. In a bereavement group for widows, one of the new members hears a longer-term member describe that the group support has helped her adjust to the loss of her husband. The new member states, "Well, maybe I can get through this, too." This statement is evidence of which of the following therapeutic factors? a. Universality b. Imitative behavior c. Installation of hope d. Imparting of information

c

5. When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

c

6. A 27-year-old female client was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time." b. "Forget him. There are other fish in the sea." c. "You must be feeling very sad about your loss." d. "Why do you think he broke up with you?"

c

7. A client who is being discharged from an inpatient hospital stay has his wife bring a box of chocolates and a bouquet of flowers for his primary nurse. He presents these gifts to the nurse, saying, "Thank you for taking care of me." What is the most appropriate response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. "Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."

c

8. A client is hospitalized following a suicide attempt after breaking up with her boyfriend. She says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You are safe here. We will make sure nothing happens to you." b. "You're just lucky your roommate came home when she did." c. "What exactly do you plan to do?" d. "I don't understand. You have so much to live for."

c

8. A generalist nurse in the outpatient mental health clinic is approached by the medical director who requests that the nurse initiate a cognitive behavior therapy group. Which of these is the most appropriate action by the nurse? a. Establish a self-help group for any patients who are interested. b. Conduct cognitive behavior therapy for a small group of 7 to 10 patients. c. Educate the medical director that according to nursing practice standards, therapy groups should be conducted by nurses who have a minimum of a master's degree in psychiatric nursing. d. Ask the nursing supervisor for approval to initiate the medical director's request.

c

8. During a primary care physician appointment, a client who has been a widow for 7 years reports to the nurse that she does not want to wake up in the morning and feels there is nothing left for her. Which of these actions by the nurse is a priority? a. Listen empathically and encourage the client to find some activities to increase socialization. b. Encourage the client to discuss this with her physician. c. Assess the client for symptoms of depression and suicide risk. d. Instruct the client that grief takes a long time to resolve but that she will be feeling better soon.

c

John tells the nurse ," I think lights out at 10pm on the weekend is stupid. We should be able to watch TV until midnight." Which of the following is the most appropriate response from the nurse on the adolescent inpatient psychiatric unit.?

c. " You may bring that up in the community meeting."

Which of the following is an example of clarification of a client's message?

c. "Are you saying you were angry when that happened?" 51 The nurse is serving on a committee that is charged with reviewing the roles and responsibilities of nurses on the psychiatric unit. Which publication will the nurse bring to the first meeting? Correct b. Psychiatric-Mental Health Nursing Standards of Practice.

During visiting hours, a client who is angry at her ex-husband's charges of child neglect expresses this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism?

c. Displacement.

Specific nursing interventions for the termination phase include:

c. Helping client summarize accomplishments.

A 5-year-old child states he is the best in his class on a Pogo stick. Which outcome reflects this client's developmental task assessment as described by Erikson?

c. Initiative

According to psychoanalytic theory, the superego is concerned with:

c. Moral behavior.

Bonus Question: Carl Jung termed the public personality or the aspects of the self that one reveals to others as:

c. Persona

2. A client presents in a crisis center saying "they don't warn me and fired me after 20 year" family is unreachable by telephone to person. The nurse will interpret that a most significant reason that client is in crisis is:

can't process the event w/out usual support

What side effects are common with first generation typical antipsychotics?

can't see, can't pee, can't shit, can't spit and orthostatic HTN

What side effects are common with haloperidol?

can't see, can't pee, can't shit, can't spit and orthostatic HTN

What are anticholinergic effects?

can't see, can't pee, can't shit, can't spit, and low blood pressure

What medications are contraindicated for patients taking lithium?

can't take NSAIDS (ibuprofen, naproxen, Advil, Motrin, Aleve) or diuretics because of kidney excretion, Lithium toxicity

Communication theories believe somatization disorders most likely occur among clients who:

cannot express feeling for fear of guilt and retribution

The role of the neurotransmitters in the central nervous system is to function as

chemical messenger that cause the brain cells to turn on and off

The role of the neurotransmitters in the central nervous system is to function as a _________ that causes the brain cells to _________

chemical messenger that cause the brain cells to turn on and off

small details, irrelevant to subject is a positive communication symptom of schizophrenia known as _________.

circumstantiality

A patient who is is admitted to the emergency room with a serious knife wound, asks the nurse, "Can you hear him?" There is no one in the room other than the patient and the nurse. When asking about hallucinations, what type would concern the nurse and increase the risk of suicide?

command

A patient who was admitted to the emergency room with a serious knife wound, ask the nurse, "can you hear him?" there is no one in the room other than the patient and the nurse. When asking about hallucinations, what type would concern the nurse and increase the risk for suicide?

command

A client who admits to having a frequent suicidal ideation is admitted to the psychiatric inpatient unit. During the assessment interview the client says, "I don't really need to be here, I'm very much at peace with myself now." The nurse should interpret that the client probably:

continues to be a significant risk for suicide

hypothalamus "HYPO Thermostat" is the area of brain responsible for

coordination of both the autonomic nervous system and the activity of the pituitary, controlling body temperature, thirst, hunger, and other homeostatic systems, and involved in sleep and emotional activity.

What 4 factors can prevent a patient from attempting suicide?

coping skills, community, religion, and access to care (Someone who has skills in problem-solving, coping, and conflict resolution is at less risk. Connectedness to community (family, school, etc.) and integration of social network and cultural and religious beliefs that discourage suicide also reduces risk. Another important factor is access to social serviced, healthcare, mental, physical and SUD treatment, and ongoing support in these areas.)

during a client admission, it is important for the nurse to obtain the family history for mental disorders because:

correct family history may assist in decisions about diagnosis and treatment

The ANA standards for the psychiatric nurse at the basic level of practice include:

counseling clients to improve coping skills

during the initial interview with a client the nurse begins to feel uncomfortable and realizes the clients behavior and mannerisms Remind the nurse of the nurses abusive parents. The nurse concludes that the current situation represents which phenomenon?

counter transference

Mr. Effing Reports that he is using a herb that controls his anxiety and wonders if is it allowed during his hospitalization. What is the most important consideration when answering this question?

cultural and individual preferences

Mr. Effiong Reports that he is using a herb that controls his anxiety and wonders if is it allowed during his hospitalization. What is the most important consideration when answering this question?

cultural and individual preferences

1. A client who is angry with his psychiatrist says to the nurse, "He doesn't know what he is doing. That medication isn't helping a thing!" The nurse responds, "He has been a doctor for many years and has helped many people." This is an example of what nontherapeutic technique? a. Rejecting b. Disapproving c. Probing d. Defending

d

10. A group of clients in a long-term psychiatric hospital setting complains to the nurse that they feel like there's not much to do during the day. One client says, "It seems like we're just sitting around watching TV all day." Which of these actions by the nurse best supports a therapeutic milieu? a. Instruct clients that the milieu is intentionally designed to provide for relaxation and minimal structured activities. b. Suggest that the clients organize some games and activities for their peers. c. Instruct these clients that they should be focusing on getting better rather than complaining. d. Explore with clients and IDT members activities that would create more structure and support treatment goals.

d

10. A nurse is conducting a diabetic medication education group for patients on a medical unit. Which of these actions by the nurse is the most important priority during the first meeting of this group? a. Ask the patients where they would like to begin. b. Try to identify what role each of the members is assuming. c. Conduct fingerstick blood sugars on each attendee. d. Explain how the meetings will be structured.

d

2. A psychiatric nurse is leading a group for women who desire to lose weight. The criterion for membership is that members must be at least 20 pounds overweight. All have tried to lose weight on their own many times in the past without success. At their first meeting, the nurse provides suggestions as the members determine what their goals will be and how they plan to go about achieving those goals. They decide how often they want to meet and what they plan to do at each meeting. Which type of group and style of leadership is described in this situation? a. Task group, autocratic leadership b. Teaching group, democratic leadership c. Self-help group, laissez-faire leadership d. Supportive-therapeutic group, democratic leadership

d

2. Anna states that Lucky was her closest friend, and since his death, no one can ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? a. Physiological needs b. Self-esteem needs c. Safety and security needs d. Love and belonging needs

d

3. A client is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain the client's suicide attempt in which of the following ways? a. She feels hopeless about her future without her boyfriend. b. Without her boyfriend, she feels like an outsider with her peers. c. She is feeling intense guilt because her boyfriend broke up with her. d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

d

4. The nurse is working with a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. The nurse and the client work together to identify goals for developing more adaptive ways to handle anger. b. The client expresses a desire to continue in the anger management program after the goals have been met. c. The nurse reviews the client's medical record and assesses his or her personal feeling about working with a client who abused their spouse. d. The nurse assists the client in practicing various techniques to effectively manage anger and provides positive feedback when the client attempts to improve maladaptive behaviors.

d

8. A client says to the nurse, "I think that meditation might be a good thing for reducing anxiety but I've never learned how to do it." Which of these would be the most appropriate response by the nurse? a. Instruct the client that antianxiety medication must be taken before engaging in meditation. b. Ask why the client never learned this method of relaxation. c. Educate the client about the evidence supporting pet therapy as the most effective psychosocial coping mechanism. d. Educate the client about how to engage in mindfulness meditation.

d

9. A client approaches the nurse and says, "I'm sick of the rules on this unit about not touching each other. I'm an adult and if I want to give one of the ladies a massage, it's my own business." Which of these responses best incorporates milieu therapy principles? a. "If you don't follow the established rules, you will be put in seclusion." b. "You don't make the rules, so just do as you're told." c. "Why are you on this unit?" d. "Let me try to explain why these rules are important for everyone's safety."

d

9. A client tells the nurse, "My spouse and I got into a big fight and I just stormed out because I didn't know what else to do." Which action by the nurse is a priority at this point? a. Encourage the client to seek legal advice from a divorce lawyer. b. Ask the client to describe the spouse's side of the story. c. Affirm the client's response as the most appropriate way to reduce anxiety in such situations. d. Assist the client to describe the event.

d

9. A client was involved in an automobile accident while under the influence of alcohol. She swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? a. "Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again." b. "You know that was a terrible thing you did. That child could have been killed." c. "I'm sure everything is going to be okay now that you understand the possible consequences of such behavior." d. "How are you feeling about what happened?"

d

5. A client who has been in rehabilitation for alcohol dependence returns from a visit to his home and tells the nurse, "We were having a celebration and I did have one drink, but it really wasn't a problem." The nurse notices that his breath smells of alcohol. Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. "You are obviously not motivated to change, so perhaps we should discuss your discharge from the treatment program." b. "You need to abstain from alcohol in order to recover, so let me talk to the doctor about the consequences of your behavior." c. "Why would you destroy everything you've worked so hard to achieve?" d. "What do you mean when you say, 'It really wasn't a problem'?"

d (motivational interviewing: patient-centered style of communicating that promotes behavior change by guiding patients to explore their motivation for change and the advantages and disadvantages of their decisions.)

6. A client who has been diagnosed with schizophrenia and has been on medication for several months states, "I'm not taking that stupid medication anymore." Which of the following responses by the nurse demonstrates a motivational interviewing style of communication? a. "Don't you know that if you don't take your medication you will never recover?" b. "Why won't you cooperate with the treatment your doctor prescribed?" c. "Bill, the medication is not stupid." d. "Tell me more about why you don't want to take the medication."

d (motivational interviewing: patient-centered style of communicating that promotes behavior change by guiding patients to explore their motivation for change and the advantages and disadvantages of their decisions.)

A 36-year-old patient has been in the hospital for 3 weeks. She has used Valium "to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse, "I don't know if I will make it without Valium after I go home. I'm, already starting to feel nervous. I have so many personal problems." Which is the most appropriate response by the nurse?

d. "Starting today, you and I are going to think about some alternative ways for you to deal with those problems-things that you can do to decrease your anxiety without resorting to drugs."

Nurse G. is assessing a patient who gives the impression of being anxious. Nurse G. seeks to validate this impression because anxiety is:

d. A subjective experience of the individual.

Mr. Effiong reports that he is using an herb that controls his anxiety and wonders if it is allowed during his hospitalization. What is the most important consideration when answering this question?

d. Cultural and individual preferences.

What type of therapy expects patients to be on time for scheduled activities, sets limitations and encourages their patients to face the realities of life in the here and now?

d. Milieu therapy

While completing the nursing admission of a patient admitted to the general hospital for surgery, the nurse observes that the patient is experiencing a narrowed perceptual field and seems to focus on immediate concerns. The patient is able to follow directions with assistance. The nurse determines that the patient is experiencing anxiety at the:

d. Moderate level.

A client is admitted to the emergency department after a car accident, but does not remember anything about it. The client is using which defense mechanism?

d. Repression.

During which stage described by Selye is the person most vulnerable to disease?

d. Stage of exhaustion. 4

15 The nurse would evaluate which of the following characteristics as indicative of healthy boundaries?

d. Taking responsibility to meet one's own needs.

Psychoanalysts believe that behavior problems in adulthood are caused by:

d. Unresolved issues in early development stages.

Define what occurs during the Orientation phase of the nurse-patient relationship.

defining the problem mutually with the client (stages of the nurse-patient relationship Page 28)

Tortocollis

deformity of the neck caused by shortening of the neck muscles causing head to twist

What ego-defense mechanism is described in the following: "A woman drinks alcohol every day and cannot stop, failing to acknowledge that she even has a problem." Projection. Denial. Reaction formation. Sublimation.

denial

What ego-defense mechanism is described in the following: Refusing to acknowledge the existence of a real situation or feelings associated with it. Projection. Denial. Reaction formation. Sublimation.

denial

A persuasive, excessive, and unrealistic need to be cared for is characteristic of which of the following personality disorders?

dependent personality disorder

A 22- year- old recent nursing school graduate has been sleeping more than usual for the past month, some times up to 14 hours. The graduate feels fatigued throughout the day. In addition, there is a loss of interest in socializing, poor appetite with a ten pound weight loss and it is hard to concentrate on studying for the nursing board exam. These symptoms are vegetative signs indicative of the following issues?

depression

SSRIs are the first line of treatment for __________ three psychiatric disorders.

depression, OCD, and PTSD

Brain imaging includes all of the following except:

dexamethasone suppression test (DST)

what would the nurse expect to find when assessing a client with obsessive compulsive personality disorder?

difficulty completing projects

during visiting hours a client who is angry at her ex-husband's charges of child neglect expresses this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism?

displacement

An acute care nurse practitioner is able to care for a terminally ill cancer patient by separating feelings and emotional reactions to the patient's inevitable death. The NP focuses on the treatment not the prognosis.

dissociation

3. dissociative process usually trauma with sudden identity disturbance and inability to recall important personal events :

dissociative amnesia

The following describes which dissociative disorder? A dissociative process usually trauma induced results in a sudden identity disturbance owing to the inability to recall important personal information is

dissociative amnesia

*Flashbacks in PTSD take a person to a _________ state

dissociative state

Define what occurs during the Termination phase of the nurse-patient relationship.

dissolved the links between nurse and client (stages of the nurse-patient relationship Page 28)

Because lithium acts as salt, what medications must you be careful about perscribing to bipolar patients taking lithium?

diuretics can cause lithium toxicity

1.A client tells the nurse," I consider it my goal to burn down the neighbor's house with him in it. It is pay back for what he did to me." The nurse is confronted with;

duty to warn

What is Extrapyramidal Syndrome (EPS)

dyskinesia (erratic movements), dystonia (involuntary movements), Parkinsonian, NMS. EPS can be assessed with "AIMS" abnormal involuntary movement scale ON TEST!!!

What stage of erikson's development matches the following statement: "have i live a meaningful life or squandered my time?"

ego integrity vs. despair

which teaching need is important when a client is newly prescribed buspirone ( buspar) 5mg tid?

encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks

which teaching need is important when a client is newly prescribed buspirone (Buspar) 5mg tid?

encourage the client to take the medication continually as prescribed because onset of action is delayed 2-3 weeks

What is the Role of the Nurse in Milieu Therapy?

establish trust, create structured activities for growth, support, validation, active listening, and communication

What is Tardive Dyskinesia (TD)?

facial movements, tapping feet, smacking/sucking lip, sticking out tongue

What is Agoraphobia and how is it treated?

fear of place that you can't escape (keeps people bound to home) Treatment: gradual fear facing in a step progression program

Do second or first generation antipsychotics have more EPS side effects?

first Generation typical have more EPS side effects than second generation

restrictive emotional response, poor eye contact, no emotion showing on face describes which symptom of schizophrenia?

flat affect, Apathy

How long does psychosis need to be present before a patient can be categorized as schizophrenia?

for 6 months

A client who is experiencing difficulties with working memory, planning and prioritizing tasks. In planning the nursing care, the nurse will apply knowledge that these symptoms represent problems with the:

frontal lobe

The nurses ability to be open and honest and real and interactions with clients is described by which characteristic that enhances the chief meant of the nurse-client relationship?

genuineness

What should you do if a patient on haloperidol cannot move their chin to their chest?

give Benadryl

A client is exhibiting sedation, auditory hallucinations, dystonia, and grandiosity. The client is prescribed haloperidol (Haldol) 5mg tid and benztropine (Cogentin) 2mg bid. which statement about this medication is accurate?

haloperidol (haldol) would assist the client to decrease grandiosity

The student nurse realizes that individuals who self mutilate may:

have experience childhood abuse and have difficulty processing feelings.

What 3 professions have the highest suicide rate?

healthcare workers, lawyers, and insurance agents.

perceptual disturbance (audiotory, visual, olfactory, taste, tactile) is what type of positive schizophrenia symptom?

hearing voices

Temporal Lobe is the area of brain responsible for

hearing, memory, language, comprehension, emotions

specific nursing interventions for the termination phase includes:

helping client summarize accomplishments

A student complains to the PMHNPA student health on campus that she has too much stress in her life. The psychiatric nurse practitioner tells her that the level of stress people experience depends primarily on?

how they appraised the events of life

Alcohol, aged cheese, and processed meats can cause what serious complication for a patient taking MAOIs?

hypertensive crisis

MAOIs can't be taken with tyramine foods because they can cause __________.

hypertensive crisis

A client with complaints of changes in appetite, feeling fatigued, problems with the sleep-rest cycle and changes in libido. The neuroanatomical area of the brain responsible for the normal regulation of these functions is the

hypothalamus

A client with complaints of changes in appetite, feeling fatigued, problems with the sleep-rest cycle and changes in libido. The neuroanatomical area of the brain responsible for the normal regulation of these functions is the ________

hypothalamus

What standards must be met for a nurse to work in mental health?

i. Basic Level of Practice = Psychiatric-mental health nurse (PMH) -diploma, associates, or bachelors -responsibilities for milieu, contact with clients Read Standards and Levels of Practice and the skills associated with basic level of psychiatric nursing and advanced level, page 24 -25 (kenis)

guidelines related to "duty to warn" states that the professional should consider taking action to warn a third-party when the client does which of the following?

identifies a specific intended victim

What is Trauma informed care?

identifies and considers the impact of previous trauma when developing a care plan for patients causes the patient is at risk for vulnerable re-traumatization

What is the goal of Cognitive Behavior Therapy?

identify and change dysfunctional patters of thinking Underactive thyroid can manifest as depression (hypothyroidism)

What stage of erikson's development matches the following statement: "who am i?"

identity vs. role confusion

What standards must be met for an advanced practice nurse to work in mental health?

ii. Advanced Practice Registered Nurse (APRN) - can use CS to signify "certified specialist" -nurse practitioner, master's or PhD

Where is Dopamine produced

in substantia nigra

Where is the hippocampus located

in temporal lobe

What is Adjustment disorder?

inability to function socially or occupationally in response to an identifiable stressor, it is a type of maladaptive response that includes feeling of anxiety and/or depression when adjusting to new circumstances like losing a job, divorce, move, etc.

The nurse should monitor for which of the following in the client taking venlafaxine (Effexor)?

increased blood pressure

What stage of erikson's development matches the following statement: "am I competent or am I worthless?"

industry vs. inferiority (5 to 13 yrs old are learning self-esteem which will lead to competence and confidence in their abilities)

A five-year-old child states that he is the best in his class at Pogo stick. Which outcome reflects this clients developmental task assessment as described by Erickson?

initiative

What stage of erikson's development matches the following statement: "am i a good person or a bad person?"

initiative vs. guilt (because preschool age kids can develope guilt in this stage)

What stage of erikson's development matches the following statement: "shall i share my life with another person or live alone?"

intimacy vs. isolation

which of the following is the most important factor in assessment of a suicide plan?

is the method and weapon easily available?

what is Neuroleptic Malignant Syndrome (NMS)

life threatening reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, diaphoresis, rapid deterioration which can cause death. If pt. experiences stop giving the meds!!!! Call the HCP

you are a nurse assigned to a unit where the majority of the clients have a personality disorder. You would expect that the treatment of personality disorder is:

likely to be resistant because of the inflexibility of the behavioral patterns

You are a nurse assigned to a unit where the majority of the clients have a personality disorder. You would expect that the treatment of personality disorder is:

likely to be resistant because of the inflexibility of the behavioral patterns.

Don't take furosamide with ________ psych drug

lithium

What mood stabilizer is the drug of choice for bipolar?

lithium

*What is important to teach family members concerning Avolition in patients with schizophrenia?

looks like laziness to family, so it is important to educate family that pt is not just lazy

an 18-year-old client who join the military after graduating from high school is admitted to the mental health unit for depression and suicidal ideation. He tells the nurse that the military is not what he expected and he wants to go home. The nurse observes a variance in his affect between his interactions with fellow clients and staff. The nurse suspects:

malingering

The hospitalist admission note mentions that a 75-year-old patient has sundown syndrome. The nurse expects the patient will:

manifest confusion and agitation after the sunset at night

In order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for:

memory impairment

in order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for:

memory impairment

in order to plan for the care of a client on an acetylcholinesterase inhibitor, the nurse should assess for:

memory impairment (acetylcholinesterase inhibitors treat Alzheimer's disease)

well completing the nursing admission of a patient admitted to the general hospital for surgery, the nurse observed that the patient is experiencing a narrowed perceptual field and seems to focus on immediate concerns. The patient is able to follow directions with assistance. The nurse determines that the patient is experiencing anxiety at the:

moderate level

according to psychoanalytic theory, the super ego is concerned with:

moral behavior

according to psychoanalytic theory, the super ego is concerned with:

moral behavior (super ego: "I shouldn't **** Gertrude without consent and I'll contemplate my weight before eating this sandwich." ego: "I want to **** Gertrude and eat this sandwich." id: "I want to **** and eat.")

To understand and participate in therapeutic communication the nurse must understand which of the following:

more than half of all message communicated are nonverbal.

Why do you need to monitor lab values for lithium?

narrow therapeutic range of 0.6 -1.2

A cognitive therapy tool that helps a client visualize the negative outcomes of a poor decision is:

negative imagery

Anosognosia

no awareness of illness

What are caritas as they relate to Milieu therapy?

non-judgmental affection (the nurse's ability to express benevolent affection for a patient regardless of their characteristics)

*How is Buspirone (Buspar) different from other anxiolytics?

not a benzo or CNS depressant, no lab test for Buspar, onset action 2-4 weeks

after completing a third electroconvulsive therapy treatment, the patient says, "I haven't been able to remember anything since the last treatment, it wasn't like this last time." The nurses best response is to:

notify the physician of the patient's increased memory loss

Hildegard Peplau's theory on interpersonal relationships in nursing includes the concept of?

nurse-client relationship

Which mental health team member uses manual and creative techniques to elicit desired interpersonal and intrapsychic responses to teach self-help activities and prepare a client to seek employment? Occupational therapist. Recreational therapist Psychosocial rebab therapist.

occupational therapist.

*What collaborative treatment is helpful for patients with Depression?

offer patient a structure program, making decisions in depression is too energy consuming

The client of Asian extraction ask the nurse why the clients own dose of antipsychotic medication is effective yet so much lower than other clients who are mostly from European extraction. Which nursing response is correct?

often people of Asian extractions have lower metabolic rates and need lower amounts of medication

The concept of blaming as the cause of mental illness is based on the belief that:

people cause their own problems

Carl Jung termed the public personality or the aspects of the self that one reveals to others as:

persona

A 22-year-old male patient is diagnosed with schizophrenia, the nurse knows that he is often forgetful and seems distracted in activities. Furthermore, he has difficulty completing tasks. The nursing plan of care will address strategies based on the understanding that these behaviors are due to:

problems in cognitive functioning

What ego-defense mechanism is described in the following: "A man who is addicted to alcohol blames his wife for his excessive drinking." Denial. Rationalization. Projection. Regression.

projection

What ego-defense mechanism is described in the following: Attributing feelings or impulses unacceptable to one's self to another person Denial. Rationalization. Projection. Regression.

projection

The Rorschach (ink blot) test and the Blackie pictures are examples of:

projective personality test

The nurse is serving on a committee that is charged with reviewing the roles and responsibilities of nurses on the psychiatric unit. which publication Will the nurse bring to the first meeting?

psychiatric Mental Health Nursing Standards of Practice

The symptoms of "flashback" is a manifestation of which of the following psychological states?

psychosis

discharge plans are being developed for a client who requires some assistance with improving decision-making and socialization post discharge. What type of program might be included in the discharge plans?

psychosocial clubhouse

What is Paroxetine (Paxil) used to treat?

ptsd and ocd It has a P and an O in it so just remember those to remember Paroxetine

Serotonin is produced in the alimentary tract in which area:

raphi nuclei

The client who has been taking buspirone (Buspar) For one month returns to the clinic for a follow up assessment. The nurse determines that the medication is effective if the absence of which manifestation occurs:

rapid heartbeat or anxiety

What ego-defense mechanism is described in the following: Preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behaviors Regression. Sublimation. Reaction formation. Denial.

reaction formation

before a newly admitted anxious client begins treatment with benzodiazepines "it is most important for the nurse to assess the clients:

recent use of alcohol or other depressants

Which mental health team member uses art, music, dance, and literature to facilitate interpersonal experiences and increase social responses and self-esteem? Occupational therapist. Recreational therapist Psychosocial rebab therapist.

recreational therapist.

What ego-defense mechanism is described in the following: "When a 2-year old is hospitalized for tonsilitis, he will only drink from a bottle, even though his mother states he has been drinking from a cup for 6 months." Regression. Sublimation. Suppression. Projection.

regression

What ego-defense mechanism is described in the following: Retreating in response to stress to an earlier level of development and the comfort measure associated with that level of function Regression. Sublimation. Suppression. Projection.

regression

which part of the brain is responsible for arousal, wakefulness, and sleep regulation

reticular activating system

The client asks the nurse how SSRI antidepressant that is prescribed works. What the nursing response is correct?

sSRIs allow more of the chemical transmitter, serotonin, to be available to areas of the brain.

The nurse is working with a client who has a history of impulsive and self-harming behaviors. The nurse will need to address which of the following in the plan of care?

safety

A client who has panic attacks whenever he sees waterfalls because he witnessed the death of his friend, who fell while climbing above the waterfall, may benefit from the feature of cognitive and behavioral treatment of:

seeking social supports to help him grieve

Parietal is the area of brain responsible for

sensory, touch, pressure

Paxil (Paroxatine) and Zoloft (Sertaline) allow more _________ to be available in brain by inhibiting uptake of it.

serotine

What neurotransmitter do second generation antipsychotics work on besides dopamine?

serotonin

SNRIs, like Bupropion (Wellbutrin), Effexor (venlafaxine), can cause what serious complication?

serotonin syndrome

There is an increased risk of experiencing ____________ when SSRIs are given with MAOIs.

serotonin syndrome

Your patient on Bupropion (Wellbutrin) or Effexor (venlafaxine) has a high blood pressure and fast pulse. What serious complication of SNRIs might be occurring?

serotonin syndrome

Which area of the brain deals with short term memory and which deals with long term and memory recall?

short = temporal long/recall = hippocampus

The nurse is attempting to establish a therapeutic relationship with an angry, depressed client on a psychiatric unit. What is the most appropriate nursing intervention?

show respect that is not based on the clients behavior.

The nurse should monitor for all the client taking Clozapine (Clozaril) EXPECT:

significant weight loss

If patient present with hopelessness and worsening signs and symptoms of depression after taking anti-depressant, always assess for _______.

signs and symptoms of suicide

What is Acute Stress Disorder and how does it compare to PTSD?

similar to PTSD, but AD symptoms are time-limited and last up to a month following trauma, if persists >1 month then it becomes PTSD

*What is the cardinal sign of major depressive disorder (MDD)?

sleep disturbances (cardinal sign is awakening early in morning)

Reticular Activating System is the area of brain responsible for

sleep regulation, arousal, wakefulness (on test)

loose association vs word salad

squirreling from one thought to another Words that are not related, and are just random words put together Clanging: words rhyme but might not have connection

during which stage described by Selye is the person most vulnerable to disease?

stage of exhaustion

A nurse is caring for a client with a terminal illness. The client asked the nurse will pray with the client for the remission of the cancer. The nurse does not practice the same religion and does not believe that remission is possible at this stage of the disease. The nurse should:

stand silently for a few moments while the client prays

4. A client experienced as nightmare during the first night in the hospital, he describes the dream was about gunfire and people getting killed. The nurses most appropriate initial intervention is

stay with the pt. and reassure him of his safety

What ego-defense mechanism is described in the following: Rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive Suppression. Reaction formation. Rationalization. Sublimation.

sublimation

Safety precautions may be implemented for what type of patient?

suicidal.

What ego-defense mechanism is described in the following: "I don't want to think about that now. I'll think about that tomorrow." Suppression. Reaction formation. Rationalization. Sublimation.

suppression

What ego-defense mechanism is described in the following: The voluntary blocking of unpleasant feelings and experiences from one's awareness Suppression. Reaction formation. Rationalization. Sublimation.

suppression

slight connection to subject is a positive communication symptom of schizophrenia known as _________.

tangential communication

The nurse and Mr. R have had eight sessions Mr. R tells the nurse "I got to the point where I was feeling pretty good, but now I'm beginning to get anxious again. I don't know if I'll be able to handle things on my own. Things feel uncertain, like they did when I was at home to go to college." The nurse and Mr. are most likely are entering which phase of the relationship?

termination

What is the Treatment for adjustment disorder?

therapy (family and behavioral), self-help groups, crisis intervention, meds (anxiety and depression)

in educating the family, what would you teach regarding the negative symptoms of psychiatric disability?

these symptoms should not be confused with laziness or manipulation

How can you check if a patient is having a dystonic reaction to haloperidol, a first generation antipsychotic?

they can't move chin to neck

*What are the three cardinal signs of OCD?

thoughts (obsessive), compulsion(actions), and ritualistic actions

The nurses monitor for all of the following for the client taking clozapine (Clozaril) EXCEPT:

thyroid functions

______ are highly lethal and easy to overdose on, so you should not give them to _______ patients.

to SI patients

Dosage adjustments w/ anti-depressants have nothing to do with _________, it is to correct signs, symptoms and SEs.

tolerance

What is Serotonin Syndrome?

too much serotonin causes agitation, tachycardia, HTN, loss muscle coordination, and confusion which can lead to seizures

A client taking lithium carbonate (Eskalith) reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5mEq/L. The nurse interprets this level as:

toxic

*What is the best treatment for Seasonal Affective Disorder (SAD)?

treatment is SSRIs and Light Therapy used regularly until seasons change

What stage of erikson's development matches the following statement: "is my social world predictable and supportive?"

trust vs. mistrust

The nurse is working with a client and family. When planning care the nurse will consider principles underlying psychobiological research including which of the following concepts:

understanding the role of neurotransmitters in the formation of behavior is valuable to nursing care

What is Implosion therapy

used for phobias, the client is instructed to stop session as soon as anxiety is experienced

Benztropine (Cogentin)

used to treat symptoms of Parkinson's disease, involuntary muscle movements, or dystonia (weak muscles)

Rank the following in order of reliability in expressing attitudes and feelings, from least to most. Non-verbal communication. Verbal communication. Paralanguage.

verbal is the least, paralanguage, and non-verbal is the most reliable.

When does the nurse-patient relationship end in Milieu therapy?

when the patient is discharged. To improve a patient's function and psychological health by manipulating their environment. (Goal of milieu therapy: manipulate the environment so that al aspects of the client's hospital experience are considered therapeutic, expected to learn adaptive coping, interaction, relationship skills that can be adapted to other aspects of client's life . This improves psychological health and functioning of an individual.)

phases are not all related but sound alike describes what positive symptom related to excessive speech pattern in schizophrenia?

word salad

What is the most important factor to remember when a patient is on a one-to-one suicide watch?

you must be eye to eye at all times (Nursing interventions when pt. is on suicide watch: observe 1:1, can't take shower alone, you MUST be eye-to-eye, 1:1, can't leave your presence)

How can you create boundaries with a client? What five ways does Murtagh want you to remember?

• Physical distance (critical distance) appropriate space between you and client • Boundaries with gift giving • Physical contact is a "no no" unless asked and appropriate • Being "real" self-disclosure shows authenticity, but be aware of the timing, appropriateness, and degree of what you're disclosing to patient • Consider culture, value, and beliefs w/ boundaries